Energy Achievement Rate Is an Independent Factor Associated with Intensive Care Unit Mortality in High-Nutritional-Risk Patients with Acute Respiratory Distress Syndrome Requiring Prolonged Prone Positioning Therapy

Abstract

Early enteral nutrition (EN) and a nutrition target >60% are recommended for patients in the intensive care unit (ICU), even for those with acute respiratory distress syndrome (ARDS). Prolonged prone positioning (PP) therapy (>48 h) is the rescue therapy of ARDS, but it may worsen the feeding status because it requires the heavy sedation and total paralysis of patients. Our previous studies demonstrated that energy achievement rate (EAR) >65% was a good prognostic factor in ICU. However, its impact on the mortality of patients with ARDS requiring prolonged PP therapy remains unclear. We retrospectively analyzed 79 patients with high nutritional risk (modified nutrition risk in the critically ill; mNUTRIC score ≥5); and identified factors associated with ICU mortality by using a Cox regression model. Through univariate analysis, mNUTRIC score, comorbid with malignancy, actual energy intake, and EAR (%) were associated with ICU mortality. By multivariate analysis, EAR (%) was a strong predictive factor of ICU mortality (HR: 0.19, 95% CI: 0.07–0.56). EAR >65% was associated with lower 14-day, 28-day, and ICU mortality after adjustment for confounding factors. We suggest early EN and increase EAR >65% may benefit patients with ARDS who required prolonged PP therapy.

Prone position, time to reach nutrition target, and energy/protein achievement rate on the seventh day of intensive care unit stay in patients with COVID‐19: A cohort study

“…A retrospective study of 79 patients who were critically ill with moderate‐to‐severe ARDS without COVID‐19 receiving PP therapy within the first 3 days of ICU admission also demonstrated lower EAR during this period in comparison with the following 4 days without PP (42.0% vs 64.5%). The low EAR observed in this study, regardless of the PP position, may have been influenced by the severity of patients at ICU admission (APACHE II median = 31 and SOFA median = 10) 12 . Retrospective data collection precluded us from evaluating the EAR, considering the delivered energy instead of the prescribed energy.…”

“…The low EAR observed in this study, regardless of the PP position, may have been influenced by the severity of patients at ICU admission (APACHE II median = 31 and SOFA median = 10). 12 Retrospective data collection precluded us from evaluating the EAR, considering the delivered energy instead of the prescribed energy. This may explain the higher values of EAR observed in our study, regardless of PP, in comparison with the available data in the literature discussed.…”

“…9,10 A retrospective study of 112 patients with COVID-19 admitted to the ICU showed that the energy achievement rate (EAR) was 59.1% in patients who underwent PP and 88.3% in those who did not receive PP. 11 In addition, Fu et al 12 demonstrated in a multivariate analysis that a higher EAR was a protective factor for death (hazard ratio = 0.19; 95% CI, 0.07-0.56) in patients with SARS who requiring prolonged PP therapy.…”

Risk of Acute Respiratory Distress Syndrome in Community-Acquired Pneumonia Patients: Use of an Artificial Neural Network Model

“…ATP-sensitive potassium channels increase in case of endotoxemia and are also involved in the pathogenesis of alveolar epithelial barrier failure, explaining the importance of potassium in the ARDS [ 25 , 26 ]. Fu et al reported that high body temperature, high systolic blood pressure, and diabetes were not associated with the development of ARDS [ 27 ]. Our results were consistent with those reported in available studies.…”

The NUTRIC Score as a Tool to Predict Mortality and Increased Resource Utilization in Intensive Care Patients with Sepsis

“…The conceptual model for the development of the NUTRIC score incorporated predictor markers of acute starvation, chronic starvation, acute inflammation, and chronic inflammation [ 22 ]. In contrast to many widely used nutritional risk assessments, this score was developed specifically for use in patients admitted to the intensive care unit [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. One potential drawback of the mNUTRIC score originates from the characteristics of the study group that were used to develop the score; the study was based on a relatively small group (n = 597) consisting mainly of Caucasian patients (90%) [ 1 ].…”