Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5224_Библиотеки_им_академика_М_И_Перельмана.pdf
220 L. Moretto et al.
immunonutrition. Eventually, a 2019 Cochrane metanalysis of ten trials investigating immunonutrition in ARDS reported only uncertain bene fits on 28-day mortality,
duration of mechanical ventilation, ICU length of stay, and oxygenation, with a
generally low quality of evidence. However, negative outcomes associated with
omega-3 FA were only observed in a bolus administration with low protein regimen
[
20]. Significant advantage instead seems to derive from the intravenous use of fish
oil (FO) emulsions—which is the most common source of omega-3 FA. One
metanalysis of 49 prospective randomized controlled trials showed a 40% and a
56% lower risk of infection and sepsis, respectively, by using FO emulsions as
compared to standard lipid emulsions [
through FO is generally recommended. When PN is used, FO dose should range
from 0.1 to 0.2 g/kg/day [2].
Lastly, some aspects of ARD
influence on MNT.
21]. Therefore, the provision of omega-3 FA
S treatment need further discussion because of their
Oral Versus Enteral Versus Parenteral Nutrition
Studies show that non-intubated patients in acute respiratory failure are largely
underfed. Oral feeding is recommended, but not always possible, due to the inability
to eat during noninvasive ventilation or because of altered mental status. Moreover,
enteral support may increase the risk of aspiration and noninvasive ventilation
duration, while large-diameter feeding tubes may cause air leakage. In this setting,
guidelines favor the oral route, but when nutritional targets are not met, oral
supplements first and then EN should be considered, introducing PN only when
the enteral route is inadequate or contraindicated [2, 13].
Specific Settings: Post-extubation Dysphagia, Tracheostomy,
and Prone Position
Post-extubation dysphagia is a common yet poorly recognized condition, affecting
around 18% of all ICU patients, and associated with severe complications, such as
aspiration pneumonia, prolonged ICU and hospital stay, and increased morbidity and
mortality. Although underlying mechanisms are unknown, endotracheal tube placement and prolonged mechanical ventilation are considered key risk factors [22]. Oral
feeding must be delayed and the risk of aspiration assessed if a swallowing disorder
is recognized after screening for dysphagia. If any risk is present, EN should be
provided through post-pyloric feeding. Otherwise, texture-adapted food can be
considered. When EN is impossible, PN should replace it [2].
case of tracheostomy, oral route is preferred as well, and the same
In the
indications as for non-intubated patients apply [2].
20 Nutrition in ARDS, COVID-19, and ECMO 221
Nutritional suppor t in non-intubated patients is therefore a complex topic, and
several factors need to be considered, such as swallow ability, mental status, type of
ventilatory support, and disease phase. In this scenario, multidisciplinarity is the key
to the MNT [
Prone position is a life-saving practice in moderate-severe ARDS, often
employed for several days during the acute phase. The enteral route is the preferred
one for feeding in the ICU, and its early initiation is desired [2, 13], thus making its
implementation in prone patients necessary. There are some concerns that the prone
position increases the risk of gastric intolerance, with higher residual gastric volume
and vomiting [
confirmed in ARDS, where a diet with a high ratio of EN during pronation was
associated with a lower mortality [24], without increasing adverse events risk [25].
Finally, in case of fluid restriction, it becomes necessary to avoid a harmful
positive fluid balance. Concentrated enteral and parenteral formulas may be useful
to reach the set nutrients and caloric goals while decreasing the administered feeding
volume.
2].
23]. Nonetheless, the beneficial effect of the enteral route was
Nutrition in COVID-19 Respiratory Failure
In 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
was identified as the cause of the coronav irus disease 2019 (COVID-19) pandemic,
which became a global health emergency. Penetration of SARS-CoV-2 into the body
takes place in the lungs through the ACE-2 receptor, whereby the prevalent respiratory involvement. However, this cell-surface receptor is also present in the kidney,
blood vessels, and heart, which accounts for its multisystem involvement. SARSCoV-2 patients can be asymptomatic or show a wide range of mild (e.g., cough,
chills, fever, fatigue, and dyspnea) and severe manifestations, such as ARDS, heart
failure, and septic shock [26].
Inflammati
the most severe cases, where multiple organ damage is attributable to uncontrolled
inflammation with massive pro-inflammatory cytokine release [26].
Nutritional risk is highly prevalent in COVID-19 patients and its etiology is
multifactorial. The inflammatory response, and the subsequent hypermetabolic
state, increases energy and protein needs. Disease severity, with a high systemic
inflammation burden, is associated with greater weight loss [27]. Comorbidities add
complexity to meeting nutritional requirements. Reduced food intake is also implicated, usually as a consequence of the typical COVID-19 gastrointestinal symptoms,
such as nausea, emesis, diarrhea, ageusia/dysgeusia, and anosmia. Furthermore, two
of the most common risk factors for severe COVID-19, obesity and older age, are
also risk factors for both malnutrition and metabolic impairment [28].
Sarcopenia
hypoxemia, and mechanical ventilation may all cause loss of muscle mass and
function. The need for social isolation during the outbreaks may have led to
plays a key role in the pathogenesis of COVID-19, particularly in
on
is also highly prevalent: systemic inflammation, immobilization,
222 L. Moretto et al.
decreased physical activity and malnutrition, especially in the elderly [29]. Overall,
poor nutritional status is linked to worse outcomes in hospitalized COVID-19
patients, including mortality and length of hospital stay [28]; thus, identification of
risk and presence of malnutrition should be undertaken early during hospitalization
[29]. The use of scores such as mNUTRIC [30], NRS 2002 [31], and GLIM [32]is
recommended [29]; in particular, the ICU-validated mNUTRIC correlates well with
28]
28-day mortality in the critically ill [
Based on practical
guides and expert statements, nutritional management in
.
COVID-19 patients should mainly follow international guidelines. Despite large
debate about the “atypicality” of COVID-19-related ARDS, management and outcomes seem to be very similar to the “typical” form of ARDS [33] and so should be
MNT, including management of non-intubated patients, caloric and protein targets,
provision of omega-3 FA, and EN during prone position. However, some specific
features need to be addressed [29, 34].
As p
usly mentioned, immunity and inflammation are largely involved in the
revio
development of clinical manifestations, especially the most severe ones. On the one
hand, an appropriate nutritional status is necessary to optimally support an activated
immune system, with increased energy demands, while on the other hand it can help
regulate the process avoiding the overactivation of the inflammatory response. Viral
infections are characterized by a compromised immune function and deficient
micronutrient stores, particularly those involved in the immune system homeostasis,
such as vitamins A (the so-called “anti-infective” vitamin), D, and E, and trace
elements, including zinc, iron, selenium, magnesium, and copper [35]
ow levels of
. L
these components have been associated with adverse outcomes during viral infection
and, during the first outbreak in China their supplementation, together with omega-3
FA, was proposed [36]. While the European Society of Clinical Nutrition and
Metabolism (ESPEN) micronutrient guidelines highly encourage prevention and
treatment of micronutrient deficiencies, they do not support their routine use,
based on the lack of evidence that supraphysiologic and supratherapeutic amounts
may improve clinical outcomes [37]
owever, in a 2020 practical guidance for
. H
nutritional management of individuals with COVID-19 infection, ESPEN suggested
that provision of daily allowances for vitamins and trace elements be ensured to
malnourished patients at risk for or with COVID-19, aiming at maximizing general
anti-infection nutritional defenses [29].
Finally,
transmission through aerosol and droplets is now well demonstrated, and
feeding tube placement and gastric residual volume measurement are aerosolgenerating procedures, through which the SARS-CoV-2 virus is spread. Therefore,
these procedures should follow strict protection protocols, and despite being enteral
the preferred route, some authors even discourage jejunal tube placement in case of
gastric intolerance, favoring PN as a safer alternative [34].
20 Nutrition in ARDS, COVID-19, and ECMO 223
Nutrition in ECMO Support
ECMO is a form of temporary mechanical support for refractory cardiorespiratory
failure. It represents a bridge to recovery, in the acute phase of an illness, as well as a
long-term support, like in patients waiting for transplantation. The venous-venous
(VV) configuration both draws and pumps back venous blood through a central vein
to add oxygen and remove carbon dioxide, providing only respiratory support.
Venous-arterial (VA) ECMO also vicariates cardiovascular function, draining
blood from a central vein and returning it into a central or peripheral artery. Because
of the extracorporeal flow of blood and its contact with the foreign circuit elements,
anticoagulation is needed to prevent platelets and coagulation activation [38].
Patients managed with ECMO represent a cohort of severe critically ill patients,
in whom providing good nutritional support becomes even more complicated for the
following reasons:
1. A major hypermetabolic state, with enhanced protein catabolism, in the context of
prolonged ICU stay and in addition to an underlying disease [39].
2. Given the severity of the condition, feeding may be perceived as secondary, and
at the moment, Extracor poreal Life Support Organization (ELSO) guidelines do
not contain speci fic indications about MNT [38].
Moreover, perceived barriers to nutrition, together with some adjunctive specific
considerations, have been reported.
Enteral Nutrition
Concerning EN, clinicians have long been reluctant towards early feeding because of
high risk of enteral intolerance due to severe hypoxemia, cardiovascular instability,
steroids, vasoactive drugs, and long-term sedation, often with neuromuscular
blockage.
In fact, observational studies show that early (<48 h) EN, alone or in combination
with PN, is feasible in up to 80% of patients [40]. It does not seem to increase the risk
of adverse events, like aspiration pneumonia and diarrhea, compared to non-ECMO
patients. Importantly, the incidence of bowel ischemia in these studies is low
(0.3–0.7%) [40, 41 ].
One study found a high prevalence of mesenteric ischemia in refractory shock
undergoing VA-ECMO support, but a negative relationship between mesenteric
ischemia and early EN [42].
Overall, early EN appears to be safe, in the presence of close surveillance and
feeding initiation once the initial stabilization is complete [41].
Inspite of
with prokinetics, and energy goals were reached in more than 70% of cases with EN
alone or in combination with PN [40, 43].
high enteral intolerance incidence (38–53%), this was treated safely
224 L. Moretto et al.
Of note, a mortality advantage was found for early versus late EN initiation,
whether substrate targets were fulfilled or not [40, 43].
Early EN in ECMO is therefore suggested, once the early phase of clinical
instability is over, and the same indications about EN intolerance—such as
prokinetics and post-pyloric feeding—apply as for non-ECMO patients [2, 13, 44].
Parenteral Nutrition
The risk of gastrointestinal bleeding in the anticoagulated ECMO patient may
contraindicate or discourage clinicians from enteral tube placement, although no
guidelines establish precise coagulation parameters cut-offs. Possible alternatives
may be tube placement before anticoagulation starts or once the bleeding risk is
resolved and total PN [
Specific concerns about PN also exist, mainly regarding its suppos ed influence on
the circuit, and vice versa. It seems that the concomitant use of intravenous lipid
emulsions and ECMO may damage circuit elements, causing clogging of the
membrane and clot formation [39]. Therefore, German guidelines suggest administering PN not directly into the ECMO circuit but through a dedicated central venous
line, and giving intravenous lipids by continuous infusion, as opposed to boluses
[45]. Guidelines not only admit PN during ECMO but advocate it when unresolving
enteral tolerance puts the patient at risk of iatrogenic malnutrition [2, 13, 44].
39].
Specific Clinical Conditions: Gastrointestinal Bleeding,
Positive Fluid Balance, and Feeding Interruptions
Not even ischemia-related hepatitis or hyperbilirubinemia in the context of
hypoperfusion, both common in VA-ECMO, should prevent clinicians from starting
parenteral support when needed, because PN-related liver dysfunction is associated
only with long- term PN and overfeeding.
nal n
Additio
We already pointed out the concerns about the risk of gastrointestinal bleeding
[39]. The same issues about fluid balance as in ARDS are found in this cohort: a
positive fluid balance is linked to worse outcomes whereby feeding restriction
strategies are often adopted. A higher risk of nutrition inadequacy was highlighted
in VA-ECMO especially [40, 41]. Another aspect is that ECMO patients often
experience diet stops on occasion of various procedures related to their severe
conditions (e.g., bronchoscopy, surgery, imaging) [41]
Given such
appropriate goals and monitor their correct achievement, taking into account the
stops.
utritional risk also comes from contingency-specific characteristics.
.
a high nutritional and diet inadequacy risk, it is essential to establish
20 Nutrition in ARDS, COVID-19, and ECMO 225
Nutritional Goals
IC implementation to measure REE was deemed impossible during ECMO support.
Two studies addressed the problem and eventually demonstrated IC applicability.
The first one proposed the “Measuring Energy Expenditure in ECLS Patients
(MEEP) protocol,” consisting of adding to the IC-measured REE of the natural
lung the contribution of mem brane lung, calculated through weir equation (VO
resulting from the pre- and post-oxygenator difference in PO2 and PCO2,
VCO
2
times ECMO blood flow) [
46]. The other group added the calorimeter directly to the
oxygenator [47]. These approaches hold some advantages as well as drawbacks: in
the first case, high technical feasibility goes along with the fact that blood gas
analysis of the circuit is a punctual measurement, which may not reflect REE; in
the second case, the stability of the results copes with the cumbersomeness of the
procedure. Moreover, both techniques need validation.
Interestingly, these studies also point out that classical predictive equations, like
Harris-Benedict’s, over- and underestimate REE in ECMO patients (both VA and
VV). This may be because the increasing levels of support reduce patients’ oxygen
consumption and/or REE varies according to the disease phase [47]. Current guidelines do not supply specific indications, but given these results, IC may be considered the gold standard and, if not available, caloric targets may be estimated with the
body weight-based formula of 25 kcal/kg/day.
Moving on to protein goals, general indications apply [2, 13], but as previously
said, there is some evidence that patients on ECMO develop an exceptionally serious
catabolic state. Two studies suggested that guideline targets could not meet their
high protein requests, especially for obese patients [48]. How increasing the protein
supply would impact the outcome is not known, but adjusting the protein supply to
nitrogen balance is suggested [2, 13].
Lastly, drug sequestration in ECMO circuits is a well-known phenomenon, with
changes in drug pharmacokinetics. This has raised concerns about the hypothesis
that plasma levels of nutrients and trace elements may undergo alterations due to the
circuit elements themselves. One study found that some micro- and macronutrients,
such as vitamins A and E as well as some amino acids, may bind to membrane
oxygenator and tubing [49]. However, this was not con firmed in a subsequent
analysis [50]. Both studies were ex vivo experiments with limitations, and guidelines
do not recommend any specific nutrient supplementations [37].
2
and
Conclusions
ARDS management, including the most severe forms undergoing ECMO support,
should include a comprehensive approach to assess the patient nutritional status by
clinical assessment, laboratory biomarkers, validated scores on outcome prediction,
and calorimetry to guide as earlier as possible MNT. The COVID-19 pandemic
226 L. Moretto et al.
clearly highlighted that clinical nutrition must be fully considered part of a medical
therapy that may influence the course of illness. To achieve the right nutritional
support, especially in a critical care setting, optimal adherence to guidelines and
knowledge of these conditions—including patients’ comorbidities and frailty—are
needed, as they may improve relevant clinical outcomes, like mortality and longterm quality of life.
References
1. Matejovic M, Huet O, Dams K, Elke G, Vaquerizo Alonso C, Csomos A, et al. Medical
nutrition therapy and clinical outcomes in critically ill adults: a European multinational,
prospective observational cohort study (EuroPN). Crit Care. 2022;26(1):143.
2. Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline
on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48–79.
3. Rezoagli E, Magliocca A, Bellani G, Pesenti A, Grasselli G. Development of a critical care
response – experiences from Italy during the coronavirus disease 2019 pandemic. Anesthesiol
Clin. 2021;39(2):265–84.
4. Chapple LAS, IWK K, Summers MJ, Weinel LM, Gluck S, Raith E, et al. Muscle protein
synthesis after protein administration in critical illness. Am J Respir Crit Care Med. 2022;206
(6):740–9.
5. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised
European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16–31.
6. Giani M, Rezoagli E, Grassi A, Porta M, Riva L, Famularo S, et al. Low skeletal muscle index
and myosteatosis as predictors of mortality in critically ill surgical patients [Internet]. In
Review; 2021 Sep [cited 2023 Mar 31]. https://www.researchsquare.com/article/rs-681091/v2
7. Goligher EC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, et al. Mechanical
ventilation–induced diaphragm atrophy strongly impacts clinical outcomes. Am J Respir Crit
Care Med. 2018;197(2):204–13.
8. Grassi A, Ferlicca D, Lupieri E, Calcinati S, Francesconi S, Sala V, et al. Assisted mechanical
ventilation promotes recovery of diaphragmatic thickness in critically ill patients: a prospective
observational study. Crit Care. 2020;24(1):85.
9. Talpers SS, Romberger DJ, Bunce SB, Pingleton SK. Nutritionally associated increased carbon
dioxide production. Chest. 1992;102(2):551–5.
10. Reignier J, Plantefeve G, Mira JP, Argaud L, Asfar P, Aissaoui N, et al. Low versus standard
calorie and protein feeding in ventilated adults with shock: a randomised, controlled,
multicentre, open-label, parallel-group trial (NUTRIREA-3). Lancet Respir Med. 2023;11:
602–12. https://doi.org/10.1016/S2213-2600(23)00092-9.
11. Bellani G, Foti G, Spagnolli E, Milan M, Zanella A, Greco M, et al. Increase of oxygen
consumption during a progressive decrease of ventilatory support is lower in patients failing
the trial in comparison with those who succeed. Anesthesiology. 2010;113(2):378–85.
12. Weyland W, Schuhmann M, Rathgeber J, Weyland A, Fritz U, Laier-Groeneveld G, et al.
Oxygen cost of breathing for assisted spontaneous breathing modes: investigation into three
states of pulmonary function. Intensive Care Med. 1995;21(3):211–7.
13. Compher C, Bingham AL, McCall M, Patel J, Rice TW, Braunschweig C, et al. Guidelines for
the provision of nutrition support therapy in the adult critically ill patient: The American Society
for Parenteral and Enteral Nutrition. J Parenter Enter Nutr. 2022;46(1):12–41.
14.
Haugen HA,
Pract. 2007;22(4):377–88.
Chan LN, Li F. Indirect calorimetry: a practical guide for clinicians. Nutr Clin
20 Nutrition in ARDS, COVID-19, and ECMO 227
15. Fetterplace K, Gill BMT, Chapple LS, Presneill JJ, MacIsaac C, Deane AM. Systematic review
with meta-analysis of patient-centered outcomes, comparing international guideline–
recommended enteral protein delivery with usual care.
610–20.
16. Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G, et al. Early versus
late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365(6):506–17.
17. de Azevedo JRA, Lima HCM, Frota PHDB, Nogueira IROM, de Souza SC, Fernandes EAA,
et al. High-protein intake and early exercise in adult intensive care patients: a prospective,
randomized controlled trial to evaluate the impact on functional outcomes. BMC Anesthesiol.
2021;21(1):283.
18. Gadek JE, DeMichele SJ, Karlstad MD, Pacht ER, Donahoe M, Albertson TE, et al. Effect of
enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients
with acute respiratory distress syndrome. Crit Care Med. 1999;27(8):1409–20.
19. Pontes-Arruda A, DeMichele S, Seth A, Singer P. The use of an inflammation-modulating diet
in patients with acute lung injury or acute respiratory distress syndrome: a meta-analysis of
outcome data. JPEN J Parenter Enteral Nutr. 2008;32(6):596–605.
20. Dushianthan A, Cusack R, Burgess VA, Grocott MP, Calder PC. Immunonutrition for acute
respiratory distress syndrome (ARDS) in adults. Cochrane Emergency and Critical Care Group,
editor. Cochrane Database of Systematic Reviews [Internet]. 2019 Jan 24 [cited 2023 Apr
5];2019(1). http://doi.wiley.com/10.1002/14651858.CD012041.pub2
21. Pradelli L, Mayer K, Klek S, Omar Alsaleh AJ, Clark RAC, Rosenthal MD, et al. ω-3 fatty-acid
enriched parenteral nutrition in hospitalized patients: systematic review with meta-analysis and
trial sequential analysis. J Parenter Enter Nutr. 2020;44(1):44–57.
22. Zuercher P, Moret CS, Dziewas R, Schefold JC. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. Crit Care. 2019;23(1):103.
23. Reignier J, Thenoz-Jost N, Fiancette M, Legendre E, Lebert C, Bontemps F, et al. Early enteral
nutrition in mechanically ventilated patients in the prone position. Crit Care Med. 2004;32(1):
94–9.
24. Fu PK, Chao WC, Hsu CY, Wang CH, Wang CY. Caloric intake with high ratio of enteral
nutrition associated with lower hospital mortality for patients with acute respiratory distress
syndrome using prone position therapy. Nutrients. 2021;13(9):3259.
25. Al-Dorzi HM, Aldawood AS, Tamim H, Haddad SH, Jones G, McIntyre L, et al. Caloric intake
and the fat-to-carbohydrate ratio in hypercapnic acute respiratory failure: post-hoc analysis of
the PermiT trial. Clin Nutr ESPEN. 2019;29:175–82.
26. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with
2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.
27. Di Filippo L, De Lorenzo R, D’Amico M, Sofia V, Roveri L, Mele R, et al. COVID-19 is
associated with clinically significant weight loss and risk of malnutrition, independent of
hospitalisation: a post-hoc analysis of a prospective cohort study. Clin Nutr. 2021;40(4):
2420–6.
28. Thomas S, Alexander C, Cassady BA. Nutrition risk prevalence and nutrition care recommendations for hospitalized and critically-ill patients with COVID-19. Clin Nutr ESPEN. 2021;44:
38–49.
29. Barazzoni R, Bischoff SC, Breda J, Wickramasinghe K, Krznaric Z, Nitzan D, et al. ESPEN
expert statements and practical guidance for nutritional management of individuals with SARSCoV-2 infection. Clin Nutr. 2020;39(6):1631–8.
30. Heyland DK, Dhaliwal R, Jiang X, Day AG. Identifying critically ill patients who benefit the
most from nutrition therapy: the development and initial validation of a novel risk assessment
tool. Crit Care. 2011;15(6):R268.
Kondrup J.
31.
controlled clinical trials. Clin Nutr. 2003;22(3):321–36.
Nutritional risk screening (NRS 2002): a new method based on an analysis of
J Parenter Enter Nutr. 2020;44(4):
228 L. Moretto et al.
32. Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, et al.
GLIM criteria for the diagnosis of malnutrition – a consensus report from the global clinical
nutrition community. Clin Nutr. 2019;38(1):1–9.
33. Ferrando C, Suarez-Sipmann F, Mellado-Artigas
Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are
similar to other causes of ARDS. Intensive Care Med. 2020;46(12):2200–11.
34. Thibault R, Seguin P, Tamion F, Pichard C, Singer P. Nutrition of the COVID-19 patient in the
intensive care unit (ICU): a practical guidance. Crit Care. 2020;24(1):447.
35. Alkhatib A. Antiviral functional foods and exercise lifestyle prevention of coronavirus. Nutrients. 2020;12(9):2633.
36. Zhang L, Liu Y. Potential interventions for novel coronavirus in China: a systematic review. J
Med Virol. 2020;92(5):479–90.
37. Berger MM, Shenkin A, Schweinlin A, Amrein K, Augsburger M, Biesalski HK, et al. ESPEN
micronutrient guideline. Clin Nutr. 2022;41(6):1357–424.
38. Tonna JE, Abrams D, Brodie D, Greenwood JC, Rubio Mateo-Sidron JA, Usman A, et al.
Management of adult patients supported with venovenous extracorporeal membrane oxygenation (VV ECMO): guideline from the Extracorporeal Life Support Organization (ELSO).
ASAIO J. 2021;67(6):601–10.
39. Stoppe C, Nesterova E, Elke G. Nutritional support in patients with extracorporeal life support
and ventricular assist devices. Curr Opin Crit Care. 2018;24(4):269–76.
40. Davis RC, Durham LA, Kiraly L, Patel JJ. Safety, tolerability, and outcomes of enteral nutrition
in extracorporeal membrane oxygenation. Nutr Clin Pract. 2021;36(1):98–104.
41. Flordelís Lasierra JL, Montejo González JC, López Delgado JC, Zárate Chug P, Martínez
Lozano-Aranaga F, Lorencio Cárdenas C, et al. Enteral nutrition in critically ill patients under
vasoactive drug therapy: the NUTRIVAD study. J Parenter Enter Nutr. 2022;46(6):1420–30.
42. Renaudier M, de Roux Q, Bougouin W, Boccara J, Dubost B, Attias A, et al. Acute mesenteric
ischaemia in refractory shock on veno-arterial extracorporeal membrane oxygenation. Eur Heart
J Acute Cardiovasc Care. 2021;10(1):62–70.
43. Kim S, Jeong SK, Hwang J, Kim JH, Shin JS, Shin HJ. Early enteral nutrition and factors related
to in-hospital mortality in people on extracorporeal membrane oxygenation. Nutrition. 2021;89:
111222.
44. ESICM Working Group on Gastrointestinal Function, Reintam Blaser A, Starkopf J,
Alhazzani W, Berger MM, Casaer MP, et al. Early enteral nutrition in critically ill patients:
ESICM clinical practice guidelines. Intensive Care Med. 2017;43(3):380–98.
45. Elke G, Hartl WH, Kreymann KG, Adolph M, Felbinger TW, Graf T, et al. Clinical nutrition in
critical care medicine – guideline of the German Society for Nutritional Medicine (DGEM).
Clin Nutr ESPEN. 2019;33:220–75.
46. Wollersheim T, Frank S, Müller MC, Skrypnikov V, Carbon NM, Pickerodt PA, et al. Measuring Energy Expenditure in extracorporeal lung support Patients (MEEP) – protocol, feasibility and pilot trial. Clin Nutr. 2018;37(1):301–7.
47. De Waele E, Jonckheer J, Pen JJ, Demol J, Staessens K, Puis L, et al. Energy expenditure of
patients on ECMO: a prospective pilot study. Acta Anaesthesiol Scand. 2019;63(3):360–4.
48. Pelekhaty SL, Galvagno SM, Lantry JH, Dolly KN, Herr DL, Kon ZN, et al. Are current protein
recommendations for the critically ill adequate for patients on VV ECMO: experience from a
high-volume center. J Parenter Enter Nutr. 2020;44(2):220–6.
49. Estensen K, Shekar K, Robins E, McDonald C, Barnett AG, Fraser JF. Macro- and micronutrient disposition in an ex vivo model of extracorporeal membrane oxygenation. Intensive Care
Med Exp. 2014;2(1):29.
50.
Lindberg BR,
circuit on the concentration of nutritional supplements. Sci Rep. 2020;10(1):19275.
Videm V, Dahl T, Sørensen G, Fiane AE, Thiara AS. Influence of the ECMO
R, Hernández M, Gea A, Arruti E, et al.
Chapter 21
Nutrition in Trauma and Burns
Carmine Iacovazzo, Silvia Paganini, and Michela Rauseo
Introduction
Trauma and burn patients are a heterogeneous group characterized by severe catabolism and a hypermetabolic state: even more that in other patient groups, adequate
assessment of nutritional needs is essential in the management of these conditions.
Nutrition support is supposed to play a key role in mitigating the stress response and
supporting the increased metabolic needs, with the final aim of preventing
malnutrition.
The severe pathophysiological stress reaction associated with trauma and burn
induces a hypermetabolic state that can result in life-threatening malnutrition,
injury
loss of lean muscle mass, delayed wound healing, and increased susceptibility to
infection. Metabolic derangement in trauma and burns are of different degree and
duration but share the same underlying mechanism: metabolic, hormonal, and
inflammatory dysregulation.
Supplementary Information The online version contains supplementary material available at
https://doi.org/10.1007/978-3-031-66541-7_21.
C. Iacovazzo
Anesthesia and
Odontostomatological Science, University of Naples “Federico II”, Naples, Italy
e-mail: carmine.iacovazzo@unina.it
S. Paganini
SC
Rianimazione e Anestesia, ASST Ovest Milanese, Ospedale Civile di Legnano, Legnano,
Italy
e-mail: silvia.paganini@asst-ovestmi.it
M. Rauseo (
Department of Medical and Surgical Science, Anesthesia and Intensive Care Unit, University
Hospital Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy
e-mail: michela.rauseo@unifg.it
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024
A. Cotoia et al. (eds.), Nutrition, Metabolism and Kidney Support,
https://doi.org/10.1007/978-3-031-66541-7_21
Intensive Care, Department of Neuroscience, Reproductive Science and
✉)
229