Emanuele Cereda1, Amedeo Guzzardella2, Catherine Klersy3, Mirko Belliato4, Andrea Pellegrini4, Fabio Sciutti5, Silvia Mongodi5, Sara Masi1, Silvia Crotti1, Monica Savioli2, Alberto Zanella2, Francesco Mojoli5, Giacomo Grasselli2, Riccardo Caccialanza6. 1. Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. 2. Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Department of Anesthesia, Critical Care and Emergency and University of Milan, Department of Pathophysiology and Transplantation Milano, Italy. 3. Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. 4. Anesthesiology and Intensive Care Unit 2, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. 5. Anesthesiology and Intensive Care Unit 1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Medical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Italy. 6. Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. Electronic address: r.caccialanza@smatteo.pv.it.
Abstract
BACKGROUND & AIMS: The aim of this study was to evaluate the nutritional support management in mechanically ventilated coronavirus disease 2019 (COVID-19) patients and explore the association between early caloric deficit and mortality, taking possible confounders (i.e. obesity) into consideration. METHODS: This was a prospective study carried out during the first pandemic wave in the intensive care units (ICUs) of two referral University Hospitals in Lombardy, Italy. Two hundred twenty-two consecutive mechanically ventilated COVID-19 patients were evaluated during the ICU stay. In addition to major demographic and clinical data, we recorded information on the route and amount of nutritional support provided on a daily basis. RESULTS: Among patients still in the ICUs and alive on day 4 (N = 198), 129 (65.2%) and 72 (36.4%) reached a satisfactory caloric and protein intake, respectively, mainly by enteral route. In multivariable analysis, a satisfactory caloric intake on day 4 was associated with lower mortality (HR = 0.46 [95%CI, 0.42-0.50], P < 0.001). Mild obesity (body mass index [BMI] ≥30 and < 35 kg/m2) was associated with higher mortality (HR = 1.99 [95%CI, 1.07-3.68], P = 0.029), while patients with moderate-severe obesity (BMI≥35 kg/m2) were less likely to be weaned from invasive mechanical ventilation (HR = 0.71 [95%CI, 0.62-0.82], P < 0.001). CONCLUSIONS: This study confirmed the negative prognostic and clinical role of obesity in mechanically ventilated COVID-19 patients and suggested that early caloric deficit may independently contribute to worsen survival in this patients' population. Therefore, any effort should be made to implement an adequate timely nutritional support in all COVID-19 patients during the ICU stay.
BACKGROUND & AIMS: The aim of this study was to evaluate the nutritional support management in mechanically ventilated coronavirus disease 2019 (COVID-19) patients and explore the association between early caloric deficit and mortality, taking possible confounders (i.e. obesity) into consideration. METHODS: This was a prospective study carried out during the first pandemic wave in the intensive care units (ICUs) of two referral University Hospitals in Lombardy, Italy. Two hundred twenty-two consecutive mechanically ventilated COVID-19patients were evaluated during the ICU stay. In addition to major demographic and clinical data, we recorded information on the route and amount of nutritional support provided on a daily basis. RESULTS: Among patients still in the ICUs and alive on day 4 (N = 198), 129 (65.2%) and 72 (36.4%) reached a satisfactory caloric and protein intake, respectively, mainly by enteral route. In multivariable analysis, a satisfactory caloric intake on day 4 was associated with lower mortality (HR = 0.46 [95%CI, 0.42-0.50], P < 0.001). Mild obesity (body mass index [BMI] ≥30 and < 35 kg/m2) was associated with higher mortality (HR = 1.99 [95%CI, 1.07-3.68], P = 0.029), while patients with moderate-severe obesity (BMI≥35 kg/m2) were less likely to be weaned from invasive mechanical ventilation (HR = 0.71 [95%CI, 0.62-0.82], P < 0.001). CONCLUSIONS: This study confirmed the negative prognostic and clinical role of obesity in mechanically ventilated COVID-19patients and suggested that early caloric deficit may independently contribute to worsen survival in this patients' population. Therefore, any effort should be made to implement an adequate timely nutritional support in all COVID-19patients during the ICU stay.
Authors: M Miguélez; C Velasco; M Camblor; J Cedeño; C Serrano; I Bretón; L Arhip; M Motilla; M L Carrascal; A Morales; N Brox; C Cuerda Journal: Clin Nutr Date: 2021-11-01 Impact factor: 7.643
Authors: Denise Battaglini; Chiara Robba; Andrea Fedele; Sebastian Trancǎ; Samir Giuseppe Sukkar; Vincenzo Di Pilato; Matteo Bassetti; Daniele Roberto Giacobbe; Antonio Vena; Nicolò Patroniti; Lorenzo Ball; Iole Brunetti; Antoni Torres Martí; Patricia Rieken Macedo Rocco; Paolo Pelosi Journal: Front Med (Lausanne) Date: 2021-06-04