The impact of early enteral nutrition up to scratch on the prognosis of patients with veno-arterial extracorporeal membrane oxygenation
10.3760/cma.j.issn.1671-0282.2024.11.013
- VernacularTitle:早期肠内营养达标对静脉-动脉体外膜肺氧合患者预后价值的探讨
- Author:
Yang YANG
1
;
Zhen XU
;
Jing SUN
;
Tingting YANG
;
Cui JIAO
;
Jingjing ZHANG
;
Zhenjie HU
;
Jianchao LI
Author Information
1. 河南省人民医院（郑州大学人民医院）临床营养科，郑州 450003
- Keywords:
Early enteral nutrition (EEN);
up to scratch;
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO);
Critically ill patients, Prognosis
- From:
Chinese Journal of Emergency Medicine
2024;33(11):1546-1551
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To determine the effects of early enteral nutrition (EEN) on the short-term prognosis of patients receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO).Methods:61 patients admitted to the Coronary Care Unit (CCU) of Henan Provincial Peoples' Hospital from February 2022 to March 2023 to receive VA-ECMO treatment were selected as the study objects according a retrospective survey. The patients were divided into an achievement group ( n=34) and a non-achievement group ( n=27) based on whether the feeding amount reached 70% or over of the target calories (25kcal/kg.d) on the 7th day of ECMO treatment. The general characteristics, disease information, complications, and prognosis between the two groups after ICU admission were recorded and compared. A multivariable Cox proportional hazards model was used to evaluate the impact of various factors on clinical outcomes. Kaplan-Meier analysis was used to draw survival curves for the two groups, and the predictive value of the ratio of actual EN intake to target energy was calculated by plotting the ROC curve. Results:A total of 61 patients were included, with an overall in-hospital mortality rate of 50.82% (31/61), with 32.35% (11/34) in the achievement group, and 70.37% (19/27) in the non-achievement group. Cox regression analysis revealed that the occurrence of hypoxic-ischemic encephalopathy (HR=0.341, 95% CI:0.119-0.975), ECOM weaning failure ( HR=0.269, 95% CI:0.111-0.651), and achieving EN targets on the 7th day of VA-ECMO treatment ( HR=10.891, 95% CI:1.178-100.718) were independent factors for patient mortality during hospitalization. The ROC curve for the percentage of EN achievement on the 7th day of VA-ECMO treatment and in-hospital mortality showed an area under the curve of 0.755, with a cutoff value of 0.73. Conclusion:The presence of ischemic hypoxic encephalopathy, ECOM weaning failure, and whether achieving EN targets or not is closely related to the prognosis of VA-ECMO patients. Patients who achieving EN targets of over 73% had the lowest in-hospital mortality rate. Therefore, more attention should be paid to the energy intake of VA-ECMO patients to reduce their risk of mortality.
