ECMO Nutrition and Metabolic Management in ECMO 3

Question 1

What is the most appropriate strategy for managing hyperglycemia in an ECMO patient receiving continuous enteral nutrition?

Accepted Answer

Use a continuous insulin infusion titrated per a validated insulin protocol

Answer

Discontinue enteral nutrition until glucose normalizes

Answer

Administer subcutaneous sliding-scale insulin only

Answer

Switch to parenteral nutrition with reduced dextrose concentration

Question 2

In a VV ECMO patient with acute respiratory distress syndrome (ARDS), what respiratory quotient (RQ) target from indirect calorimetry suggests optimal substrate utilization?

Accepted Answer

RQ 0.85–1.0

Answer

RQ < 0.7

Answer

RQ > 1.0

Answer

RQ = 0.7 exactly

Question 3

Which vitamin deficiency is most clinically significant and requires routine supplementation in ECMO patients due to its role in oxidative stress management?

Accepted Answer

Vitamin C (ascorbic acid)

Answer

Vitamin B12

Answer

Vitamin D

Answer

Vitamin K

Question 4

How should nutritional support be adjusted when an ECMO patient is transitioned from the acute inflammatory phase to the recovery phase?

Accepted Answer

Advance to full caloric targets and maintain high protein to support anabolism and rehabilitation

Answer

Reduce protein intake to 0.8 g/kg/day to prevent uremia

Answer

Switch entirely to parenteral nutrition to ensure reliability

Answer

Restrict carbohydrates below 100 g/day to prevent hyperglycemia

Question 5

Which feeding approach is recommended for ECMO patients who are prone positional or have impaired gastric emptying?

Accepted Answer

Post-pyloric (small bowel) enteral feeding

Answer

Gastric feeding at high rates with prokinetic agents

Answer

Intermittent bolus gastric feeds

Answer

Total parenteral nutrition exclusively

Question 6

What effect does therapeutic hypothermia (if used during ECMO) have on nutritional management?

Accepted Answer

It decreases metabolic rate, reducing caloric requirements and slowing GI motility

Answer

It increases caloric demands by 20–30% due to shivering thermogenesis

Answer

It has no significant effect on caloric needs

Answer

It causes hypercalcemia requiring calcium restriction

Question 7

What is the most important nutritional consideration when weaning an ECMO patient toward extubation and oral intake?

Accepted Answer

Transitioning gradually from enteral to oral feeding while monitoring swallowing safety

Answer

Abruptly stopping enteral feeding 24 hours before extubation

Answer

Switching to parenteral nutrition during the weaning period to reduce aspiration risk

Answer

Restricting all nutrition for 48 hours to reduce secretions