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

Continuous insulin infusion with a validated ICU insulin protocol provides the most consistent glycemic control in ECMO patients receiving continuous nutrition.

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

An RQ of 0.85–1.0 indicates balanced substrate oxidation of carbohydrates and fats, while RQ > 1.0 suggests overfeeding and net lipogenesis, increasing CO2 production.

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 C is a critical antioxidant consumed rapidly during the oxidative stress of ECMO-mediated inflammation, and supplementation has been investigated to attenuate organ dysfunction.

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

During the recovery phase, patients shift from catabolism to anabolism, and advancing to full caloric and protein targets supports muscle repair, weaning, and functional recovery.

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

Post-pyloric feeding bypasses the stomach and is preferred when gastric emptying is impaired or prone positioning makes aspiration risk prohibitive.

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO Nutrition and Metabolic Management in ECMO 3