Jéssica Alves de Paula1, Estela Iraci Rabito2, Sandra Regina Justino3,4, Luíza Silva Leite1, Danielle Dantas1, Jessica Sayume Makiyama da Silva1, Larissa Farinha Maffini1, Odery Ramos Júnior5. 1. Clinical Nutrition Unit, Clinical Hospital Complex - Federal University of Paraná, Curitiba-PR, Brazil. 2. Department of Nutrition, Federal University of Paraná, Curitiba-PR, Brazil. 3. Nutrition Department of the Brazilian Association of Intensive Care Medicine, São Paulo-SP, Brazil. 4. Nutrition Department of the Intensive Care Society of Paraná Brazil, Curitiba-PR, Brazil. 5. Department of Internal Medicine, Gastroenterology Division, Clinical Hospital Complex - Federal University of Paraná, Curitiba-PR, Brazil.
Abstract
Background: The prone position (PP) used in the treatment of critically ill patients infected with SARS-CoV-2, may be a barrier to enteral nutrition (EN). This study aimed to analyze the effectiveness and complications of EN in the PP, as well as clinical outcomes. Methods: Prospective cohort study with patients in EN and coronavirus disease 2019 (COVID-19), on mechanical ventilation (MV), which whom needed or not PP. Gastrointestinal intolerances (GII) related to PP were evaluated, and correlated with possible confounding factors. EN, days on MV, Intensive Care Unit (ICU) length of stay, hospital length of stay, ventilator-associated pneumonia (VAP) and mortality were analyzed. The data were evaluated daily and compared prone group (PG=57) and supine group (SG=69). Results: The PP was associated with GII (P=0.000) and presented in 32 patients (26,44%) with no difference among groups. Association between epinephrine (P=0.003), vasopressin (P=0.018), and GII was observed. There was no difference between the total volume of enteral nutrition (TVEN) infused in the groups. However, the mean EN infused for the days when the patient was on PP was (70.0% ± 31.5) and for the days in supine position was (74.8% ± 27.3), P= 0.006. The PG had a longer time on MV (P=0.005) and ICU (P=0.003) and PP was associated with VAP (P=<0.001). The infused TVEN showed no association with VAP (P=0.09). Conclusion: PP was a determining factor in GII and proved to be a risk factor for VAP, but the EN protocol seems to have ensured an adequate EN supply in PP and be a safe alternative.
Background: The prone position (PP) used in the treatment of critically ill patients infected with SARS-CoV-2, may be a barrier to enteral nutrition (EN). This study aimed to analyze the effectiveness and complications of EN in the PP, as well as clinical outcomes. Methods: Prospective cohort study with patients in EN and coronavirus disease 2019 (COVID-19), on mechanical ventilation (MV), which whom needed or not PP. Gastrointestinal intolerances (GII) related to PP were evaluated, and correlated with possible confounding factors. EN, days on MV, Intensive Care Unit (ICU) length of stay, hospital length of stay, ventilator-associated pneumonia (VAP) and mortality were analyzed. The data were evaluated daily and compared prone group (PG=57) and supine group (SG=69). Results: The PP was associated with GII (P=0.000) and presented in 32 patients (26,44%) with no difference among groups. Association between epinephrine (P=0.003), vasopressin (P=0.018), and GII was observed. There was no difference between the total volume of enteral nutrition (TVEN) infused in the groups. However, the mean EN infused for the days when the patient was on PP was (70.0% ± 31.5) and for the days in supine position was (74.8% ± 27.3), P= 0.006. The PG had a longer time on MV (P=0.005) and ICU (P=0.003) and PP was associated with VAP (P=<0.001). The infused TVEN showed no association with VAP (P=0.09). Conclusion: PP was a determining factor in GII and proved to be a risk factor for VAP, but the EN protocol seems to have ensured an adequate EN supply in PP and be a safe alternative.
Authors: V Marco Ranieri; Gordon D Rubenfeld; B Taylor Thompson; Niall D Ferguson; Ellen Caldwell; Eddy Fan; Luigi Camporota; Arthur S Slutsky Journal: JAMA Date: 2012-06-20 Impact factor: 56.272
Authors: Annika Reintam Blaser; Joel Starkopf; Waleed Alhazzani; Mette M Berger; Michael P Casaer; Adam M Deane; Sonja Fruhwald; Michael Hiesmayr; Carole Ichai; Stephan M Jakob; Cecilia I Loudet; Manu L N G Malbrain; Juan C Montejo González; Catherine Paugam-Burtz; Martijn Poeze; Jean-Charles Preiser; Pierre Singer; Arthur R H van Zanten; Jan De Waele; Julia Wendon; Jan Wernerman; Tony Whitehouse; Alexander Wilmer; Heleen M Oudemans-van Straaten Journal: Intensive Care Med Date: 2017-02-06 Impact factor: 17.440