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

Abstract

Background: We aimed to evaluate the mean time to reach the energy (EAR) and protein (PAR) achievement rate among patients with coronavirus disease 2019 (COVID-19) who did or did not undergo prone position (PP) therapy in the first week of their stay in the intensive care unit (ICU), and the interaction of these nutrition therapy indicators on the association between PP and clinical outcomes. Methods: This cohort study used retrospective data collected from medical records of patients with COVID-19 admitted to the ICU (≥18 years). We collected nutrition data, clinical information, prescription of PP, and its frequency during the first week, and clinical outcomes.Results: PP therapy was administered to 75.2% of 153 patients (61.5 ± 14.8 years, 57.6% males) during the first week of their ICU stay. Patients who underwent PP reached nutrition therapy goals later (4 [3-6] vs 3 [2-4] days; P = 0.030) and had lower EAR (91.9 ± 25.7 vs 101.6 ± 84.0; P = 0.002) and PAR (88.0 ± 27.7 vs 98.1 ± 13.5; P = 0.009) in comparison to those who did not receive PP. Grouping patients who underwent PP according to the EAR (≥70% or <70%) did not show any differences in the incidence of ICU death, duration of mechanical ventilation, or ICU stay (P > 0.05). Conclusions:In this exploratory study, PP was associated with a delayed time to reach the nutrition target and the lowest EAR and estimated protein requirement on the seventh day of ICU stay in patients with COVID-19. Permissive enteral nutrition prescription in patients who underwent PP was not associated with worse clinical outcomes.

Association between protocol change to a higher‐protein formula with lower energy targets and nutrient delivery in critically ill patients with COVID‐19: A retrospective cohort study

“…Protein and energy adequacy in our study was less than three other observational studies, which were conducted in critically ill patients with COVID‐19 in the United Kingdom, 37 Brazil, 38 and Mexico 39 . However, nutrition adequacy in our study was greater than the reported means for Australian populations 24 .…”

“…3 Various strategies to achieve nutrition targets have been attempted in the critically ill, including volume-based feeding strategies, 23 bolus feeding, 35 and using a very high-protein liquid formula. 36 The first two strategies, although beneficial at augmenting protein provision, require additional nursing time or a change to the Protein and energy adequacy in our study was less than three other observational studies, which were conducted in critically ill patients with COVID-19 in the United Kingdom, 37 Brazil, 38 and Mexico. 39 However, nutrition adequacy in our study was greater than the reported means for Australian populations.…”