The Influence of Prone Positioning on Energy and Protein Delivery in COVID-19 Patients Requiring ECMO Support

• Published in: Nutrients 2024-10, Vol.16 (20), p.3534
• Main Authors: Hintersteininger, Marlene, Haselwanter, Patrick, Maleczek, Mathias, Laxar, Daniel, Hermann, Martina, Hermann, Alexander, Buchtele, Nina, Staudinger, Thomas, Zauner, Christian, Schneeweiss-Gleixner, Mathias
• Format: Article
• Language: English
• Subjects: Adult; Aged; Blood oxygenation, Extracorporeal; Coronaviruses; COVID-19; COVID-19 - therapy; Critical Illness - therapy; Data collection; Dietary Proteins - administration & dosage; Energy; Energy Intake; Enteral feeding; Enteral nutrition; Enteral Nutrition - methods; Extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - methods; Female; Humans; Intensive care; Male; Malnutrition; Management; Metabolism; Middle Aged; Nutrition therapy; Pandemics; Parenteral nutrition; Patient positioning; Patient Positioning - methods; Patients; Physiological aspects; Positioning; Prone Position - physiology; Proteins; Respiratory distress syndrome; Retrospective Studies; SARS-CoV-2; Tube feeding
• ISSN: 2072-6643; 2072-6643
• DOI: 10.3390/nu16203534

Gastrointestinal dysfunction is a common complication of medical nutrition therapy in critically ill patients. Whether prone positioning leads to a deterioration in gastrointestinal function has not been fully clarified. Thus, we aimed to analyze the influence of prone positioning on the tolerance of medical nutrition therapy. We conducted a retrospective analysis of 102 SARS-CoV-2 infected patients with venovenous extracorporeal membrane oxygenation support (VV ECMO). Gastric residual volume (GRV) was used to assess the tolerance of enteral nutrition. Nutritional data were collected for 2344 days. Undernutrition was observed in 40.8%, with a significantly higher incidence on days in prone position (48.4% versus 38.6%, < 0.001). On days in supine position, significantly more calories were administered enterally than on days in prone position ( < 0.001). The mean GRV/24 h was 111.1 mL on days in supine position and 187.3 mL on days in prone position ( < 0.001). Prone positioning was associated with higher rates of GRV of ≥500 mL/24 h independent of age, disease severity at ECMO start, ECMO runtime and ICU length of stay (adjusted hazard ratio: 4.06; 95%CI: 3.0-5.5; < 0.001). Prone position was associated with lower tolerance of enteral nutrition, as indicated by an increased GRV. As a result, reduced enteral nutritional support was administered.