Abstract

Objective: Prone position (PP) is used in the treatment of severe acute respiratory distress syndrome (ARDS). The aim of our study was to evaluate the effect of PP (>24 hours) on achieving medical nutritional goals.

Materials and Methods: Between 2018 and 2022, a total of 385 patients in the Anesthesiology and Reanimation Intensive Care Unit (ICU) were included, 183 of whom were in the prone group and 202 in the Non-prone (NP) group, who underwent Invasive Mechanical Ventilator (IMV) support with ARDS. Demographic data, comorbidities and medical nutrition (MN) status of the patients were analysed retrospectively from the electronic database. The rate of achievement of MN targets on days 3.7.14 of the PP and NP groups was compared.

Results: A statistically significant low level negative correlation was found in the correlation analysis between prone time and the rate of achievement of calorie and protein targets in the PP group patients (r=-0.370, p<0.001) (r=0.303, p<0.001). The rate of severe ARDS was statistically significantly higher in the PP group than in the NP group (P<0.001). The median duration of IMV in both patient groups was over 15 days and was statistically significantly higher in the PP patient group (p<0.001).

Conclusion: PP delays the achievement of the target calorie and protein ratio, and some patients did not reach the target calorie and protein ratio.

Keywords: Prone position, ARDS, calorie target, protein target

Copyright and license

How to cite

1.
Öztürk Selçuk S, Arslan M, Özel Bilgi D, Yılmaz R, Çukurova Z. Does prone positioning affect achievement of medical nutritional goals?. Clin Sci Nutr. 2024;6(3):137-143. doi:10.62210/ClinSciNutr.2024.97

References

  1. Thibault R, Seguin P, Tamion F, Pichard C, Singer P. Nutrition of the COVID-19 patient in the intensive care unit (ICU): a practical guidance. Crit Care. 2020;24:447. https://doi.org/10.1186/s13054-020-03159-z
  2. Takahashi W, Hatano H, Hirasawa H, Oda S. Protective role of autophagy in mouse cecal ligation and puncture-induced sepsis model. Crit Care. 2013;17(Suppl 2):P1. https://doi.org/10.1186/cc11939
  3. Savio RD, Parasuraman R, Lovesly D, et al. Feasibility, tolerance and effectiveness of enteral feeding in critically ill patients in prone position. J Intensive Care Soc. 2021;22:41-46. https://doi.org/10.1177/1751143719900100
  4. McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40:159-211. https://doi.org/10.1177/0148607115621863
  5. Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38:48-79. https://doi.org/10.1016/j.clnu.2018.08.037
  6. Luft VC, Beghetto MG, de Mello ED, Polanczyk CA. Role of enteral nutrition in the incidence of diarrhea among hospitalized adult patients. Nutrition. 2008;24:528-535. https://doi.org/10.1016/j.nut.2008.02.004
  7. Haines KL, Ohnuma T, Trujillo C, et al. Hospital change to mixed lipid emulsion from soybean oil-based lipid emulsion for parenteral nutrition in hospitalized and critically ill adults improves outcomes: a pre-post-comparative study. Crit Care. 2022;26:317. https://doi.org/10.1186/s13054-022-04194-8
  8. Singer P, Blaser AR, Berger MM, et al. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clin Nutr. 2023;42:1671-1689. https://doi.org/10.1016/j.clnu.2023.07.011
  9. Grasselli G, Calfee CS, Camporota L, et al. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med. 2023;49:727-759. https://doi.org/10.1007/s00134-023-07050-7
  10. Chapple LS, Tatucu-Babet OA, Lambell KJ, Fetterplace K, Ridley EJ. Nutrition guidelines for critically ill adults admitted with COVID-19: Is there consensus? Clin Nutr ESPEN. 2021;44:69-77. https://doi.org/10.1016/j.clnesp.2021.05.003
  11. Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365(6):506-517. https://doi.org/10.1056/nejmoa1102662
  12. Reignier J, Thenoz-Jost N, Fiancette M, et al. Early enteral nutrition in mechanically ventilated patients in the prone position. Crit Care Med. 2004;32:94-99. https://doi.org/10.1097/01.CCM.0000104208.23542.A8
  13. Reignier J, Boisramé-Helms J, Brisard L, et al. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet. 2018;391:133-143. https://doi.org/10.1016/S0140-6736(17)32146-3
  14. Matejovic M, Huet O, Dams K, et al. Medical nutrition therapy and clinical outcomes in critically ill adults: a European multinational, prospective observational cohort study (EuroPN). Crit Care. 2022;26:143. https://doi.org/10.1186/s13054-022-03997-z
  15. Mehta Y, Sunavala JD, Zirpe K, et al. Practice Guidelines for Nutrition in Critically Ill Patients: A Relook for Indian Scenario. Indian J Crit Care Med. 2018;22:263-273. https://doi.org/10.4103/ijccm.IJCCM_3_18
  16. El Koofy NM, Rady HI, Abdallah SM, Bazaraa HM, Rabie WA, El-Ayadi AA. The effect of high fat dietary modification and nutritional status on the outcome of critically ill ventilated children: single-center study. Korean J Pediatr. 2019;62:344-352. https://doi.org/10.3345/kjp.2018.06835
  17. Liposky JM, Nelson LD. Ventilatory response to high caloric loads in critically ill patients. Crit Care Med. 1994;22:796-802. https://doi.org/10.1097/00003246-199405000-00014
  18. Mesejo A, Acosta JA, Ortega C, et al. Comparison of a high-protein disease-specific enteral formula with a high-protein enteral formula in hyperglycemic critically ill patients. Clin Nutr. 2003;22:295-305. https://doi.org/10.1016/s0261-5614(02)00234-0
  19. Braunschweig CA, Sheean PM, Peterson SJ, et al. Intensive nutrition in acute lung injury: a clinical trial (INTACT). JPEN J Parenter Enteral Nutr. 2015;39:13-20. https://doi.org/10.1177/0148607114528541
  20. Weijs PJ, Looijaard WG, Beishuizen A, Girbes AR, Oudemans-van Straaten HM. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Crit Care. 2014;18:701. https://doi.org/10.1186/s13054-014-0701-z
  21. Saez de la Fuente I, Saez de la Fuente J, Quintana Estelles MD, et al. Enteral Nutrition in Patients Receiving Mechanical Ventilation in a Prone Position. JPEN J Parenter Enteral Nutr. 2016;40:250-255. https://doi.org/10.1177/0148607114553232
  22. Bilgili B, Haliloğlu M, Sayan İ, Cinel İ. Association of Energy Adequacy with 28-Day Mortality in Mechanically Ventilated Critically Ill. J Turk Soc Intens Care. 2019;17:38-43. https://doi.org/10.4274/tybd.galenos.2019.30922
  23. Weimann A, Braga M, Carli F, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr. 2017;36:623-650. https://doi.org/10.1016/j.clnu.2017.02.013
  24. Davies ML, Chapple LAS, Chapman MJ, Moran JL, Peake SL. Protein delivery and clinical outcomes in the critically ill: a systematic review and meta-analysis. Crit Care Resusc. 2017;19:117-127.