Caloric Intake with High Ratio of Enteral Nutrition Associated with Lower Hospital Mortality for Patients with Acute Respiratory Distress Syndrome Using Prone Position Therapy.

Pin-Kuei Fu,Chih-Hung Wang,Chen-Yu Wang,Chiann-Yi Hsu,Wen-Cheng Chao

doi:10.3390/nu13093259

Abstract

Positioning patients in the prone position leads to reduced hospital mortality rates for those with severe acute respiratory distress syndrome (ARDS). What constitutes the optimal feeding strategy for prone patients with ARDS is controversial. We conducted a retrospective study that enrolled 110 prone patients with ARDS in two medical intensive care units (ICUs) from September 2015 to November 2018. Inclusion criteria were as follows: age ≥20 years, diagnosis of respiratory failure requiring mechanical ventilation, diagnosis of ARDS within 72 h of ICU admission, placement in a prone position within the first 7 days of ICU admission, and ICU stay of more than 7 days. Exclusion criteria were as follows: nil per os orders because of gastrointestinal bleeding or hemodynamic instability, and ventilator dependency because of chronic respiratory failure. The consecutive daily enteral nutrition(EN)/EN + parenteral nutrition(PN) ratio could predict hospital mortality rates within the first 7 days of admission when using generalized estimating equations (p = 0.013). A higher average EN/EN + PN ratio within the first 7 days predicted (hazard ratio: 0.97, confidence interval: 0.96–0.99) lower hospital mortality rates. To reduce hospital mortality rates, caloric intake with a higher EN ratio may be considered for patients in prone positions with ARDS.

Highlights

Introduction published maps and institutional affilAcute respiratory distress syndrome (ARDS) was first described in 1974 [1], with hospital mortality rates of approximately 30–40%, depending on the severity of ARDS [2].Common risk factors of ARDS are pneumonia, non-pulmonary sepsis, aspiration, noncardiogenic shock, pancreatitis, severe trauma, drug overdose, and ischemic perfusion injury [3]
Generalized estimating equations were used to estimate the association between hospital mortality rates and the daily Enteral nutrition (EN)/parenteral nutrition (PN) + EN ratios
We screened 4156 intensive care units (ICUs) patients, and 110 patients enrolled in the study (Figure 1)

Summary

Introduction

Acute respiratory distress syndrome (ARDS) was first described in 1974 [1], with hospital mortality rates of approximately 30–40%, depending on the severity of ARDS [2]. Common risk factors of ARDS are pneumonia, non-pulmonary sepsis, aspiration, noncardiogenic shock, pancreatitis, severe trauma, drug overdose, and ischemic perfusion injury [3]. ARDS patients in acute stage are at risk of barotrauma, nosocomial infection, muscle weakness, gastrointestinal bleeding, delirium, and poor nutrition [4,5,6,7,8,9]. Guiilen et al conducted a randomized controlled study that concluded that the prone position can decrease hospital mortality rates for patients with severe ARDS [11]. Enteral nutrition (EN) is the preferred method for delivering nutrients to patients in the intensive care unit (ICU) [12]. EN in critical illness is associated with many advantages including reduced inflammation, regain of muscle function, provision of micro- and iations

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Discussion

Conclusion