Resting Energy Expenditure of Patients on Venovenous Extracorporeal Membrane Oxygenation for Adult Respiratory Distress Syndrome: A Pilot Study

Chin Siang Ong; Patricia Brown; Benjamin L Shou; Christopher Wilcox; Sung-Min Cho; Pedro Alejandro Mendez-Tellez; Bo Soo Kim; Glenn J R Whitman

doi:10.1097/CCE.0000000000000730

Resting Energy Expenditure of Patients on Venovenous Extracorporeal Membrane Oxygenation for Adult Respiratory Distress Syndrome: A Pilot Study

Crit Care Explor. 2022 Jul 18;4(7):e0730. doi: 10.1097/CCE.0000000000000730. eCollection 2022 Jul.

Authors

Chin Siang Ong^{1

2}, Patricia Brown¹, Benjamin L Shou¹, Christopher Wilcox¹, Sung-Min Cho³, Pedro Alejandro Mendez-Tellez⁴, Bo Soo Kim⁵, Glenn J R Whitman¹

Affiliations

¹ Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
² Division of Surgical Outcomes, Department of Surgery, Yale School of Medicine, New Haven, CT.
³ Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, Anesthesia and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD.
⁴ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
⁵ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

Abstract

Objectives: The objectives of this study were to 1) in patients without pulmonary function, determine resting energy expenditure (REE) in venovenous extracorporeal membrane oxygenation (ECMO) acute respiratory distress syndrome (ARDS) patients by paralysis status and 2) determine the threshold tidal volume (TV) associated with meaningful gas exchange as determined by measurable end-tidal carbon dioxide elimination (etV̇co₂).

Design: Retrospective observational study.

Setting: A tertiary high ECMO volume academic institution.

Patients/subjects: Ten adult ARDS patients on venovenous ECMO.

Interventions: None.

Measurements and main results: The modified Weir equation, Fick principle, Henderson-Hasselbalch equation, ECMO flow, hemoglobin, and pre and post oxygenator blood gases were used to determine ECMO carbon dioxide production (V̇co₂), ECMO oxygen consumption, and REE. REE values were matched to patients' paralysis status based on medication flowsheets and compared using a paired t test. Linear regression was performed to determine the threshold TV normalized to ideal body weight (IBW) associated with measurable ventilator etV̇co₂, above which meaningful ventilation occurs. When lungs were not functioning, patients had significantly lower mean REE when paralyzed (23.4 ± 2.8 kcal/kg/d) than when not paralyzed (29.2 ± 5.8 kcal/kg/d) (p = 0.02). Furthermore, mean REE was not similar between patients and varied as much as 1.7 times between patients when paralyzed and as much as 1.4 times when not paralyzed. Linear regression showed that ventilator V̇co₂ was measurable and increased linearly when TV was greater than or equal to 0.7 mL/kg.

Conclusions: REE is patient-specific and varies significantly with and without patient paralysis. When TV exceeds 0.7 mL/kg IBW, ventilator V̇co₂ increases measurably and must be considered in determining total REE.

Keywords: adult respiratory distress syndrome; physiology; resting energy expenditure; venovenous extracorporeal membrane oxygenation.

Abstract

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