Achieving nutritional goals in prone position: A cohort study in critically ill patients with coronavirus disease

Abstract

Background

This study aimed to describe nutritional therapy and clinical outcomes in critically ill patients with coronavirus disease (COVID-19) hospitalized in an intensive care unit, submitted or not to the prone position.

Methods

This retrospective cohort study included adult patients with COVID-19 admitted to the intensive care unit (ICU) of a public university hospital from June to December 2020. Sociodemographic, clinical, nutritional, and anthropometric data were collected in electronic medical records with a prestructured collection instrument. Patients who underwent a prone position at least once during hospitalization were considered in the prone group.

Results

677 patients were included and 35.4 % were placed in the prone position. Pronated patients had a higher prevalence of obesity (p = 0.005), pressure ulcers (p < 0.001), required more mechanical ventilation (p < 0.001) and renal replacement therapy (p = 0.004), had longer hospital length of stay (p < 0.001) and higher mortality rate (p < 0.001). They required enteral nutrition more frequently and remained on this therapy for a longer duration, despite having similar caloric and protein targets. No significant differences were found in the ability to achieve nutritional goals between pronated and non-pronated patients.

Conclusion

Critically ill patients in the prone position had longer hospital stays and higher mortality rates, while being more likely to initiate and remain on enteral nutrition for a longer period. However, no significant differences were observed in the time to achieve protein and caloric goals compared to those in the supine position.