Nutrition delivery and the relationship with changes in muscle mass in adult patients receiving extracorporeal membrane oxygenation: A retrospective observational study

Clare E Ferguson; Kate Hayes; Oana A Tatucu-Babet; Kate J Lambell; Eldho Paul; Carol L Hodgson; Emma J Ridley

doi:10.1016/j.aucc.2024.02.008

Nutrition delivery and the relationship with changes in muscle mass in adult patients receiving extracorporeal membrane oxygenation: A retrospective observational study

Aust Crit Care. 2024 Apr 17:S1036-7314(24)00050-X. doi: 10.1016/j.aucc.2024.02.008. Online ahead of print.

Authors

Clare E Ferguson¹, Kate Hayes², Oana A Tatucu-Babet¹, Kate J Lambell³, Eldho Paul⁴, Carol L Hodgson⁵, Emma J Ridley⁶

Affiliations

¹ Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia.
² Physiotherapy Department, Alfred Health, Melbourne, Victoria, Australia.
³ Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia.
⁴ Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁵ Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Physiotherapy Department, Alfred Health, Melbourne, Victoria, Australia; Division of Clinical Trial and Cohort Studies, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia; The George Institute for Global Health, Australia.
⁶ Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia. Electronic address: emma.ridley@monash.edu.

PMID: 38637220
DOI: 10.1016/j.aucc.2024.02.008

Abstract

Background: Adverse changes in muscle health (size and quality) are common in patients receiving extracorporeal membrane oxygenation (ECMO). Nutrition delivery may attenuate such changes, yet the relationship with muscle health remains poorly understood. This study explored the association between energy and protein delivery and changes in muscle health measured using ultrasound from baseline to day 10 and 20 in patients receiving ECMO.

Methods: A secondary analysis of data from a prospective study quantifying changes in muscle health using ultrasound in adults receiving ECMO was completed. Patients were eligible for inclusion if they were prescribed artificial nutrition within 3 days of enrolment and had >1 ultrasound measurement. The primary outcome was the association between protein delivery (grams delivered and percentage of targets received) and change in rectus femoris cross-sectional area (RF-CSA) till day 20. Secondary outcomes were the association between energy and protein delivery and change in RF-CSA till day 10, RF-echogenicity, and quadriceps muscle layer thickness to day 10 and 20. Associations were assessed using Spearman's rank correlation.

Results: Twenty-three patients (age: 48 [standard deviation {SD}: 14], 44% male) were included. Mean energy and protein delivery were 1633 kcal (SD: 374 kcal) and 70 g (SD: 17 g) equating to 79% (SD: 19%) of energy and 73% (SD: 17%) of protein targets. No association was observed between protein delivery (r = 0.167; p = 0.495) or the percentage of targets received (r = 0.096; p = 0.694) and change in RF-CSA till day 20. No other significant associations were found between energy or protein delivery and change in RF-CSA, echogenicity, or quadriceps muscle layer thickness at any time point.

Conclusions: This exploratory study observed no association between nutrition delivery and changes in muscle health measured using ultrasound in patients receiving ECMO. Larger prospective studies are required to investigate the association between nutrition delivery and changes in muscle health in patients receiving ECMO.

Keywords: Critical illness; Extracorporeal membrane oxygenation; Nutrition; Skeletal muscle mass; Ultrasound.