Enteral nutrition practice in the prone position in patients with coronavirus disease 2019: An international one-day point prevalence analysis

Abstract

Enteral nutrition (EN) in the prone position for severe respiratory failure is considered possible with care. However, the extent to which it is feasible, especially its association with the length of intensive care unit (ICU) stay, is unclear. Therefore, we investigated the relationship between the duration of prone position therapy and adequacy of EN delivery and explored factors associated with this relationship in an observational study of critically ill patients with coronavirus disease 2019 (COVID-19) who were actively treated in the prone position. This study was a secondary analysis of a worldwide one-day prevalence study in the COVID-19 era. We investigated the care and nutritional therapy provided to critically ill patients with COVID-19 admitted to ICU, along with ICU-related information. We targeted patients who received only tube feeding and analyzed the relationship between the duration of prone position, length of ICU stays, and nutrition delivery via EN. In addition, a multivariate analysis was performed to examine factors affecting the achievement of EN delivery of 20kcal/kg/day or more in patients who were placed in the prone position for at least 6h. A total of 399 patients who received only EN, excluding parenteral nutrition and oral intake, were included, of whom 58% received EN energy delivery of ≥20kcal/kg/day; this rate increased with the length of ICU stay, regardless of the duration of prone position. In a multivariate analysis of 121 patients who were in the prone position for at least 6h, the presence of dedicated dietitians in the ICU (OR=6.91, 95% CI=1.98 to 24.1, p<0.01) was associated with a higher energy delivery. Conversely, the use of muscle relaxants (OR=0.32, 95% CI=0.11 to 0.98, p=0.04) and presence of nutrition protocols (OR=0.24, 95% CI=0.07 to 0.77, p=0.02) was associated with a lower energy delivery. Patients with COVID-19 received adequate nutrition by EN even during prone position. Target EN delivery would be achieved with the introduction of prone position.