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Total enteral nutrition versus total parenteral nutrition during pediatric extracorporeal membrane oxygenation
R Pettignano1, M Heard, R Davis
1Division of Critical Care Medicine, Egleston Children's Hospital at Emory University, Atlanta, GA 30322, USA.
Insights
Enteral nutrition is well-tolerated and adequate for pediatric patients on extracorporeal membrane oxygenation (ECMO). This method is cost-effective and complication-free compared to parenteral nutrition, suggesting safe administration for nutritional support.
Area of Science:
- Pediatric critical care medicine
- Nutritional support
- Extracorporeal life support
Background:
- Pediatric patients requiring extracorporeal membrane oxygenation (ECMO) need adequate nutritional support.
- Comparing enteral nutrition (EN) with parenteral nutrition (PN) is crucial for optimizing care in critically ill children.
Purpose of the Study:
- To evaluate the adequacy, tolerance, and complications of EN versus PN in pediatric patients on ECMO.
- To determine the safety and efficacy of EN as a primary nutritional strategy during ECMO.
Main Methods:
- Retrospective chart review of pediatric patients on ECMO from 1991-1995.
- Comparison of two groups: 14 patients on PN and 13 patients on EN (after exclusions).
- Nutritional delivery, tolerance, complications, and outcomes were assessed.
Main Results:
- No significant differences in age, weight, or ECMO parameters between EN and PN groups.
- No complications were reported with EN.
- The EN group showed a trend towards higher survival (100% vs. 79%) and significant cost savings ($170/day).
Conclusions:
- Enteral nutrition is well-tolerated, adequate, cost-effective, and safe for pediatric patients on ECMO.
- EN can be safely administered for nutritional support in this vulnerable population.
- EN offers a viable alternative to PN for pediatric ECMO patients.
Objective:
To evaluate the adequacy, tolerance, and complications of enteral nutrition, compared with parenteral nutrition, in pediatric patients requiring extracorporeal membrane oxygenation (ECMO).
Design:
A retrospective chart review of all patients placed on extracorporeal life support from January 1991 through December 1995.
Setting:
Medical/surgical pediatric intensive care unit at Egleston Children's Hospital, a tertiary care pediatric center.
Patients:
Twenty-nine consecutive pediatric patients who required ECMO and were provided nutritional support, either enterally or parenterally. Group A consisted of 14 patients who were provided nutritional support using total parenteral nutrition. Group B consisted of 15 patients. Two patients were excluded from group B because their ECMO run was <36 hrs, leaving insufficient data for analysis. The remaining 13 patients were provided total enteral nutrition during ECMO.
Interventions:
None.
Measurements And Main Results:
Both groups were similar in age, weight, pre-ECMO oxygenation index, alveolar-arterial oxygen difference, type, and duration of ECMO (p = NS). Comparison of percent ideal body weight on admission did not show a statistical difference between groups A and B (p = .883). There was no difference between the two groups in the time needed to achieve caloric goal (p = .536) from the initiation of ECMO. No complications were associated with the utilization of enteral feedings. Savings for the nutritional supplement was estimated to be $170 per day for the enterally fed group. The percentage of patients surviving was higher in the enterally fed patients compared with the parenterally fed group (79% vs. 100%), although this difference was not statistically significant (p = .47).
Conclusions:
Enteral nutrition in patients receiving either venoarterial or venovenous ECMO is well tolerated, provides adequate nutrition, is cost effective, and is without complications, as compared with parenteral nutrition. These data suggest that total enteral nutrition can be safely administered for nutritional support in pediatric patients undergoing either venoarterial or venovenous ECMO.