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.

Pin-Kuei Fu,Shih-Pin Lin,Chen-Tsung Kuo,Chen-Yu Wang,Chiann-Yi Hsu,Wei-Ning Wang

doi:10.3390/nu13093176

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.

Highlights

Enteral nutrition (EN) initiated within 48 h is recommended for all critically ill patients treated with invasive mechanical ventilation in the intensive care unit (ICU) [1,2,3,4]
Because prolonged prone positioning (PP) therapy has become the standard of care for moderate to severe acute respiratory distress syndrome (ARDS) and COVID-19-associated ARDS (CARDS), the aim of the current study investigated the association between energy achievement rate (EAR) and ICU mortality in patients with high nutritional risk and ARDS receiving prolonged PP therapy
This study identified two factors related to nutrition, namely modified nutrition risk in the critically ill (mNUTRIC) score (HR: 1.26; 95% confidence intervals (CIs): 1.01–1.58) and EAR (HR: 0.21; 95% CI, 0.07–0.64) on the fifth day after the initiation of PP therapy; this fills a gap in the research regarding the effect of nutritional support on ICU mortality for patients with ARDS requiring PP therapy

Summary

Introduction

Enteral nutrition (EN) initiated within 48 h is recommended for all critically ill patients treated with invasive mechanical ventilation in the intensive care unit (ICU) [1,2,3,4]. A systemic survey of nutritional risk within 24 h of admission is recommended, accompanied by early EN [2,3,4] to reduce the risk of infectious complications and organ failure in critically ill patients [4,5]. The ideal energy achievement rate (EAR) for the first week in the ICU is 60–70% of the nutritional target according to the 2016 American Society for Parenteral and Enteral Nutrition (ASPEN) and Society of Critical Care Medicine (SCCM) guidelines and the 2019 European Society for Clinical Nutrition and Metabolism (ESPN) guidelines [1,3,4]. The impact of EAR on the mortality of patients with high nutritional risk and acute respiratory distress syndrome (ARDS) requiring prolonged prone positioning (PP) therapy remains unclear

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Conclusion