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. 2021 Sep 12;13(9):3176.
doi: 10.3390/nu13093176.

Energy Achievement Rate Is an Independent Factor Associated with Intensive Care Unit Mortality in High-Nutritional-Risk Patients with Acute Respiratory Distress Syndrome Requiring Prolonged Prone Positioning Therapy

Pin-Kuei Fu  1   2   3   4 , Chen-Yu Wang  1   5 , Wei-Ning Wang  6 , Chiann-Yi Hsu  7 , Shih-Pin Lin  8 , Chen-Tsung Kuo  9
Affiliations

Energy Achievement Rate Is an Independent Factor Associated with Intensive Care Unit Mortality in High-Nutritional-Risk Patients with Acute Respiratory Distress Syndrome Requiring Prolonged Prone Positioning Therapy

Pin-Kuei Fu et al. Nutrients. .

Abstract

Early enteral nutrition (EN) and a nutrition target >60% are recommended for patients in the intensive care unit (ICU), even for those with acute respiratory distress syndrome (ARDS). Prolonged prone positioning (PP) therapy (>48 h) is the rescue therapy of ARDS, but it may worsen the feeding status because it requires the heavy sedation and total paralysis of patients. Our previous studies demonstrated that energy achievement rate (EAR) >65% was a good prognostic factor in ICU. However, its impact on the mortality of patients with ARDS requiring prolonged PP therapy remains unclear. We retrospectively analyzed 79 patients with high nutritional risk (modified nutrition risk in the critically ill; mNUTRIC score ≥5); and identified factors associated with ICU mortality by using a Cox regression model. Through univariate analysis, mNUTRIC score, comorbid with malignancy, actual energy intake, and EAR (%) were associated with ICU mortality. By multivariate analysis, EAR (%) was a strong predictive factor of ICU mortality (HR: 0.19, 95% CI: 0.07-0.56). EAR >65% was associated with lower 14-day, 28-day, and ICU mortality after adjustment for confounding factors. We suggest early EN and increase EAR >65% may benefit patients with ARDS who required prolonged PP therapy.

Keywords: acute respiratory distress syndrome; energy achievement rate; high nutritional risk; modified nutrition risk in the critically ill; mortality; prolonged prone positioning.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flowchart. ARDS: acute respiratory distress syndrome; ECMO: extracorporeal member oxygenation; DNR: do not resuscitate; ICU: intensive care unit.
Figure 2
Figure 2
Comparison of energy achievement rate (EAR) during the first week of intensive care unit (ICU) admission between the survival and non-survival groups. ** p < 0.01.
Figure 3
Figure 3
Hazard ratio (HR) of ICU mortality of critically ill patients with high nutritional risk and moderate to severe ARDS receiving prolong prone positioning (PP) therapy. mNUTRIC score: modified nutrition risk in the critically ill score.
Figure 4
Figure 4
EAR >65% at the fifth ICU day was significantly associated with lower ICU mortality in patients with moderate to severe ARDS receiving prolonged PP therapy. * p < 0.05.
See this image and copyright information in PMC

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