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document
Comparison of methods for intravenous infusion of fat emulsion during extracorporeal membrane oxygenation . STUDY OBJECTIVES To characterize the effects of infusing fat emulsion during neonatal extracorporeal membrane oxygenation ( ECMO ) by comparing results from patients receiving fat emulsion through the ECMO circuit with those receiving fat emulsion through separate intravenous access . A second goal was to identify the optimal route for administration . DESIGN Prospective , randomized , open-label trial . SETTING Neonatal intensive care unit in a 106-bed quaternary care pediatric hospital . SUBJECTS Nine neonates receiving ECMO who required intravenous nutrition . Intervention . Patients received 1-3 g/kg/day of fat emulsion into either the ecmo circuit or separate intravenous access . MEASUREMENTS AND MAIN RESULTS The ECMO circuit and samples of blood were evaluated hourly for phase separation , layering out of the emulsion from blood , agglutination , and blood clots . After completion , the oxygenators were dissected and examined . Data were compared with an unpaired t test . The characteristics of the groups were similar , except for a higher mean weight in the ECMO circuit group ( 3.6 +/- 0.3 kg vs 2.8 +/- 0.4 kg , p=0.03 ) . The mean +/- SD triglyceride level during the study was 87 +/- 79 mg/dl , with no significant difference between the two groups . Two patients in each group had elevated triglyceride levels . No cases of phase separation occurred . In the five patients who received fat emulsion into the ECMO circuit , three had layering out of the emulsion and agglutination , and all developed clots in the circuit despite adequate anticoagulation . Of the four patients in the intravenous-access group , one had layering and agglutination , and two had blood clots . CONCLUSIONS Although both methods were associated with layering out , agglutination , and clot formation , these effects occurred more frequently with administration into the ECMO circuit , particularly in areas of stasis . This may result in disruption of normal ECMO blood flow and impaired delivery of calories . Fat emulsion should therefore be administered through separate intravenous access during ECMO whenever possible .
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Intervention_Physical
infusion of fat emulsion
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Intervention_Pharmacological
fat emulsion
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Intervention_Pharmacological
fat emulsion
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Intervention_Pharmacological
nutrition
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Intervention_Physical
1-3 g/kg/day of fat emulsion into either the ecmo circuit or separate intravenous access
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Intervention_Pharmacological
fat emulsion
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Intervention_Pharmacological
Fat emulsion
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Outcome_Physical
weight
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Outcome_Physical
mean +/- SD triglyceride level
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Outcome_Physical
triglyceride levels
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Outcome_Physical
phase separation
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Outcome_Physical
layering out of the emulsion
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Outcome_Physical
agglutination
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Outcome_Physical
clots
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Outcome_Physical
layering out , agglutination , and clot formation