Measuring resting energy expenditure during extracorporeal membrane oxygenation: preliminary clinical experience with a proposed theoretical model
Abstract
Background Extracorporeal membrane oxygenation (ECMO) is increasingly used in patients with severe respiratory failure. Indirect calorimetry (IC) is a safe and non-invasive method for measuring resting energy expenditure (REE). No data exist on the use of IC in ECMO-treated patients as oxygen uptake and carbon dioxide elimination are divided between mechanical ventilation and the artificial lung. We report our preliminary clinical experience with a theoretical model that derives REE from IC measurements obtained separately on the ventilator and on the artificial lung. Methods A patient undergoing veno-venous ECMO for acute respiratory failure due to bilateral pneumonia was studied. The calorimeter was first connected to the ventilator and oxygen consumption (VO2 ) and carbon dioxide transport (VCO2 ) were measured until steady state was reached. Subsequently, the IC was connected to the membrane oxygenator and similar gas analysis was performed. VO2 and VCO2 values at the native and artificial lung were summed and incorporated in the Weir equation to obtain a REEcomposite . Results At the ventilator level, VO2 and VCO2 were 29.5 ml/min and 16 ml/min. VO2 and VCO2 at the artificial lung level were 213 ml/min and 187 ml/min. Based on these values, a REEcomposite of 1703 kcal/day was obtained. The Faisy-Fagon and Harris-Benedict equations calculated a REE of 1373 and 1563 kcal/day. Conclusion We present IC-acquired gas analysis in ECMO patients. We propose to insert individually…
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Indirect calorimetry may become inaccurate during ECMO support.
“Indirect calorimetry may become inaccurate during ECMO support,166,167”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [166]
Cites
The Harris Benedict equation reevaluated: resting energy requirements and the body cell mass
Roza, A. M., & Shizgal, H. M. (1984) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/40.1.168 · Cited by 824 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Indirect calorimetry in nutritional therapy. A position paper by the ICALIC study group
Oshima, T., Berger, M. M., De Waele, E., Guttormsen, A. B., Heidegger, C.-P., Hiesmayr, M., Singer, P., Wernerman, J., & Pichard, C. (2017) · Clinical Nutrition · doi:10.1016/j.clnu.2016.06.010 · Cited by 283 · see citing works
“suggested a method for conducting IC in ECMO patients [37].”
MethodIndirect Calorimetry in Clinical Practice
Delsoglio, M., Achamrah, N., Berger, M. M., & Pichard, C. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8091387 · Cited by 243 · see citing works
“Similarly, to calculate real REE on extracorporeal membrane oxygenation (ECMO) patients requires gas exchange analysis by IC at both ventilator and ECMO sides [55,56].”
MethodElke, G., Hartl, W. H., Kreymann, K. G., Adolph, M., Felbinger, T. W., Graf, T., de Heer, G., Heller, A. R., Kampa, U., Mayer, K., et al. (2019) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2019.05.002 · Cited by 150 · see citing works
Moonen, H. P. F. X., Beckers, K. J. H., & van Zanten, A. R. H. (2021) · Journal of Intensive Care · doi:10.1186/s40560-021-00524-0 · Cited by 120 · see citing works
“[74] proposed to insert consecutively obtained, individ-”
Clinical Guide for the Use of Metabolic Carts
Singer, P., & Singer, J. (2015) · Nutrition in Clinical Practice · doi:10.1177/0884533615622536 · Cited by 61 · see citing works
Wollersheim, T., Frank, S. K., Müller, M. C., Skrypnikov, V., Carbon, N. M., Pickerodt, P. A., Spies, C., Mai, K., Spranger, J., & Weber‐Carstens, S. (2017) · Clinical Nutrition · doi:10.1016/j.clnu.2017.01.001 · Cited by 61 · see citing works
Adequacy of nutrition support during extracorporeal membrane oxygenation
MacGowan, L., Smith, E. V., Elliott-Hammond, C., Sanderson, B., Ong, D., Daly, K., Barrett, N. A., Whelan, K., & Bear, D. E. (2018) · Clinical Nutrition · doi:10.1016/j.clnu.2018.01.012 · Cited by 63 · see citing works
“Two 364 methods to measure energy expenditure using indirect calorimetry in this population have 365 been described (34, 35), and feeding to measured, rather than calculated, requirements 366 may be one approach to limiting underfeeding or overfeeding in the future.”
MethodEnergy expenditure of patients on ECMO: A prospective pilot study
De Waele, E., Jonckheer, J., Pen, J. J., Demol, J., Staessens, K., Puis, L., La Meir, M., Honoré, P. M., L. N. G. Malbrain, M., & Spapen, H. D. (2019) · Acta Anaesthesiologica Scandinavica · doi:10.1111/aas.13287 · Cited by 48 · see citing works
“Data were collected minute‐to‐minute for at least 30 minutes using breath‐by‐breath technology(9) and then inserted in a modified Weir formula software program.(9) Data are presented as median with percentiles (IQR) or as indicated in the legend.”
MethodSelf-citationNutrition Support in Adult Patients Receiving Extracorporeal Membrane Oxygenation
Bear, D. E., Smith, E. V., & Barrett, N. A. (2018) · Nutrition in Clinical Practice · doi:10.1002/ncp.10211 · Cited by 54 · see citing works
Jonckheer, J., Demol, J., Lanckmans, K., Malbrain, M. L. N. G., Spapen, H. D., & Waele, E. D. (2020) · Clinical Nutrition · doi:10.1016/j.clnu.2020.04.017 · Cited by 46 · see citing works
Self-citationIndirect calorimetry as point of care testing
Rattanachaiwong, S., & Singer, P. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.12.035 · Cited by 42 · see citing works
DGEM-Leitlinie: „Klinische Ernährung in der Intensivmedizin“
Elke, G., Hartl, W. H., Kreymann, K. G., Adolph, M., Felbinger, T. W., Graf, T., de Heer, G., Heller, A. R., Kampa, U., Mayer, K., et al. (2018) · Aktuelle Ernährungsmedizin · doi:10.1055/a-0713-8179 · Cited by 76 · see citing works
Jonckheer, J., Spapen, H. D., Malbrain, M. L. N. G., Oschima, T., & Waele, E. D. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2019.02.034 · Cited by 35 · see citing works
Self-citationMetabolic and nutritional aspects in continuous renal replacement therapy
Fishman, G., & Singer, P. (2023) · Journal of Intensive Medicine · doi:10.1016/j.jointm.2022.11.001 · Cited by 32 · see citing works
“[43 , 44] Second, heat loss is partially counered by using heating devices.”
BackgroundDo PICU patients meet technical criteria for performing indirect calorimetry?
Beggs, M. R., Guerra, G. G., & Larsen, B. (2016) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2016.06.003 · Cited by 24 · see citing works
Bachmann, K., Haenggi, M., Jakob, S., Takala, J., Gattinoni, L., & Berger, D. (2020) · American Journal of Physiology - Lung cellular and Molecular Physiology · doi:10.1152/ajplung.00167.2019 · Cited by 18
“Mainstream capnography at the V-A ECMO gas outlet is feasible and may deliver accurate results for oxygen intake (V̇O2) and V̇CO2 (4, 22).”
MethodVest, A. R., DiDomenico, R. J., Lichtenstein, L., Slater, T., Ekpo, E., Damluji, A. A., Bohula, E., Alviar, C. L., on behalf of the American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology, & Council on Cardiovascular and Stroke Nursing (2026) · Circulation · doi:10.1161/cir.0000000000001405 · Cited by 15 · see citing works
Nutritional support in patients with extracorporeal life support and ventricular assist devices
Stoppe, C., Nesterova, E., & Elke, G. (2018) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000512 · Cited by 13 · see citing works
Priem, S., Jonckheer, J., Waele, E. D., & Stiens, J. H. (2023) · Sensors · doi:10.3390/s23084143 · Cited by 12 · see citing works
Methodological Aspects of Indirect Calorimetry in Patients with Sepsis—Possibilities and Limitations
Wasyluk, W., Zwolak, A., Jonckheer, J., Waele, E. D., & Dąbrowski, W. (2022) · Nutrients · doi:10.3390/nu14050930 · Cited by 17 · see citing works
Pelekhaty, S. L., Galvagno, S., Hochberg, E. S., Herr, D., Lantry, J., Kon, Z., Deatrick, K., & Menaker, J. (2020) · JPEN - Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.1176 · Cited by 12
D’Alesio, M., Martucci, G., Arcadipane, A. F., Lorusso, R., & Amrein, K. (2022) · Artificial Organs · doi:10.1111/aor.14215 · Cited by 13 · see citing works
Belliato, M., Degani, A., Buffa, A., Sciutti, F., Pagani, M., Pellegrini, C., & Iotti, G. (2017) · Journal of clinical monitoring and computing · doi:10.1007/s10877-016-9927-4 · Cited by 10
Schneeweiss-Gleixner, M., Scheiner, B., Semmler, G., Maleczek, M., Laxar, D., Hintersteininger, M., Hermann, M., Hermann, A., Buchtele, N., Schaden, E., et al. (2023) · Nutrients · doi:10.3390/nu15092098 · Cited by 6 · see citing works
Müller, M. C., Wilke, S. K., Dobbermann, A., Carbon, N., Lammel, S., Russ, M., Weber-Carstens, S., & Wollersheim, T. (2022) · ASAIO journal (1992) · doi:10.1097/mat.0000000000001662 · Cited by 6 · see citing works
Bear, D. E., Ridley, E., Daly, K., de Waele, E., Dabbous, T. A., Karpasiti, T., Stoppe, C., & Barrett, N. A. (2026) · ASAIO journal (1992) · doi:10.1097/mat.0000000000002657 · Cited by 5
“39 • To date, four techniques have been described to measure EE in ECMO patients, 22,24,30,34,48 each with limitations (full details specified in the Supplementary Appendix, Supplemental Digital Content, https://links.lww.com/ ASAIO/B832).”
Pelekhaty, S. L., Gessler, J., Dante, S. A., Rector, N., Galvagno, S. M., Stachnik, S., Rabin, J., & Tabatabai, A. (2024) · Nutrition in Clinical Practice · doi:10.1002/ncp.11132 · Cited by 6 · see citing works
Chin, S.-O., Brown, P., Shou, B., Wilcox, C., Cho, S.-M., Mendez-Tellez, P., Kim, B., & Whitman, G. (2022) · Critical Care Explorations · doi:10.1097/cce.0000000000000730 · Cited by 4
“ECMO patients represent a unique physiologic population since gas exchange may occur in both the native lung as well as the extracorporeal oxygenator, or only the latter, resulting in two separate components (ventilator and ECMO circuit) that contribute to REE (9).”
BackgroundGlebova, E. S., Иванова-Давыдова, Е. В., & Amcheslavsky, V. G. (2019) · Russian Journal of Pediatric Surgery · doi:10.18821/1560-9510-2019-23-6-329-334 · Cited by 4 · see citing works
Hintersteininger, M., Haselwanter, P., Maleczek, M., Laxar, D., Hermann, M., Hermann, A., Buchtele, N., Staudinger, T., Zauner, C., & Schneeweiss‐Gleixner, M. (2024) · Nutrients · doi:10.3390/nu16203534 · Cited by 4 · see citing works
“Although there are experimental approaches for using indirect calorimetry during ECMO support in order to provide more accurate data, these protocols have not been evaluated for routine clinical use [52,53].”
MethodMetabolic support for patients on extra-corporeal membrane oxygenation
Hileman, B., Martucci, G., & Subramanian, H. (2024) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000001162 · Cited by 2 · see citing works
Nutrition support for patients on mechanical circulatory support
Dresen, E., Modir, R., & Stoppe, C. (2023) · Current Opinion in Anaesthesiology · doi:10.1097/aco.0000000000001323 · Cited by 2 · see citing works
Challenges of Nutrition Support in Pediatric Patients Requiring Extracorporeal Membrane Oxygenation.
Zivick, E., Kilgallon, K. B., & Cheifetz, I. M. (2023) · ASAIO journal (1992) · doi:10.1097/mat.0000000000002042 · Cited by 1
Oshima, T., Oami, T., Yamashiro, M., Higashi, A., Hayashi, Y., Suga, N., Takayanagi, S., Sakao, S., & Nakada, T. (2020) · Research Square · doi:10.21203/rs.3.rs-51286/v1 · Cited by 1 · see citing works
Rocha, L. M., Shima, M., de Freitas, B. J., & Piovacari, S. (2020) · Abr-Jun · doi:10.37111/braspenj.2020352011 · Cited by 1 · see citing works
“…o propósito de viabilizar o uso da calorimetria indireta em pacientes em ECMO, estudo realizado com um paciente propôs um modelo teórico baseado em uma medição da calorimetria em dois níveis, pulmão do paciente e artificial 22 , e a inserção das medições obtidas na equação de Weir modificada 20 .”
Indirect calorimetry for metabolic monitoring in intensive care units
Sorokina, L. S., Yudina, S. S., Petrov, A. S., & Eremenko, A. A. (2024) · Восстановительные биотехнологии, профилактическая, цифровая и предиктивная медицина. · doi:10.17116/rbpdpm2024104120 · Cited by 1 · see citing works
Addressing metabolic demands during veno‐venous extracorporeal life support: A narrative review
Lammers, D. T., Wiseman, P. D., Deen, N., Thanedar, S., Baset, N., Liu, G., DellaVolpe, J. D., & Sousse, L. E. (2026) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.70088
Nutrition management of a patient following emergent pneumonectomy due to chest wall trauma
Pelekhaty, S. L., & Brody, R. A. (2025) · Nutrition in Clinical Practice · doi:10.1002/ncp.11291
“14 The Measuring Energy Expenditure in extracorporeal lung support Patients (MEEP) protocol uses blood gases drawn before and after the ECMO oxygenator to calculate VO2 and VCO2.”
Leyderman, I. N., Kasherininov, I. Y., Ponomareva, A. D., & Олегович, С. А. (2025) · Russian Journal of Anesthesiology and Reanimatology · doi:10.17116/anaesthesiology202501151
Pelekhaty, S. L., & Menaker, J. (2018) · Nutrition in clinical practice · doi:10.1002/ncp.10069
Lima, K., Santos, Z., Sbruzzi, G., Rovati, B., & Bona, L. (2021) · BRASPEN journal · doi:10.37111/braspenj.2021.36.2.10
“15, 2015 Austrália Estudo observacional prospectivo 107 Qualquer indicação 9 (5-12) 42 (31-56) Masculino 50,5% 25,8 (23-31) 13 (7-30) Gástrica 90% Entérica 10% METAS ESTIMADAS Calorias 2040 (1851-2391) kcal/dia Proteínas 95 (72-106) g/ dia APORTE RECEBIDO Calorias 1680 (960-2100) / 20 kcal/kg média Proteínas 72 (42-98…”
BackgroundInfluentialEnergy Expenditure During Extracorporeal Circulation
de Waele, E., Honore, P., & Spapen, H. (2017) · doi:10.1007/978-3-319-51908-1_14
Self-citationIndirect Calorimetry in Critically Ill Patients: Concept, Current Use, and Future Challenges
de Waele, E., Honore, P., & Spapen, H. (2016) · Annual update in intensive care and emergency medicine · doi:10.1007/978-3-319-27349-5_30
Self-citation
- Authors
- De Waele, E., van Zwam, K., Mattens, S., Staessens, K., Diltoer, M., Honoré, P. M., Czapla, J., Nijs, J., La Meir, M., Huyghens, L., & Spapen, H.
- Affiliations
- Intensive Care Department Universitair Ziekenhuis Brussel (UZ Brussel) Vrije Universiteit Brussel (VUB) Brussels Belgium
- Department of Cardiac Surgery Universitair Ziekenhuis Brussel (UZ Brussel) Brussels Belgium
- Vrije Universiteit Brussel (BE)
- Universitair Ziekenhuis Brussel (BE)
- Venue
- Acta Anaesthesiologica Scandinavica
- Publisher
- Wiley
- Published
- 2015-06-05
- Volume
- 59
- Issue
- 10
- Pages
- 1296-1302
- ISSN
- 0001-5172 (ISSN-L)
- 1399-6576
- OpenAlex
- W1922323512
- Cited by
- 51
- References
- 0
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 6 · 2023: 6 · 2022: 5 · 2021: 5 · 2020: 4 · 2019: 5 · 2018: 7 · 2017: 3 · 2016: 4 · 2015: 1
- FWCI
- 4.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Anaesthesiologica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Physical Sciences › Engineering › Biomedical Engineering › Mechanical Circulatory Support Devices
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Keywords
- extracorporeal membrane oxygenation, resting energy expenditure, indirect calorimetry, oxygen consumption, carbon dioxide elimination, Weir equation, veno-venous ECMO, acute respiratory failure, pneumonia, energy demand estimation, mechanical ventilation
- MeSH terms
- Carbon Dioxide, Energy Metabolism, Female, Humans, Middle Aged, Models, Biological, Oxygen Consumption, Extracorporeal Membrane Oxygenation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
