Clinical Nutrition Open Science (Feb 2024)

Evaluation of non-nutritional calories in intensive care patients with acute respiratory distress syndrome due to coronavirus disease-19: a retrospective observational study

  • Benjamin Popoff,
  • Emilie Occhiali,
  • Zoé Demailly,
  • Gaëtan Béduneau,
  • Dorothée Carpentier,
  • Christophe Girault,
  • Philippe Gouin,
  • Maximillien Grall,
  • Grégoire Jolly,
  • Thomas Clavier,
  • Fabienne Tamion

Journal volume & issue
Vol. 53
pp. 44 – 56

Abstract

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Summary: Background & Aims: Nutrition therapy is a critical component of care for critically ill patients in the intensive care unit (ICU). Caloric intake can be provided by artificial nutrition and also by some treatments providing non-nutritional calories (NNCs). The aim of this study was to assess the contribution of NNCs from propofol and dextrose infusions to daily caloric intake. Methods: A retrospective observational study was carried out in three ICUs of a university hospital. Mechanically ventilated patients admitted to ICU for acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) were included. Daily caloric intake, including NNCs from propofol and dextrose infusions, and calories from artificial nutrition was assessed over the initial seven days of ICU admission. Results: A total of 157 patients were included in the analysis. During the early phase of ICU admission, NNCs constituted all the proportion of caloric intake (Day 1: 100% [100–100], Day 2: 100% [100–100], Day 3: 100% [63–100]). This dominance gradually decreased with the introduction of artificial nutrition after a median of 4 days [3–5]. Propofol contributed significantly to NNCs, constituting a median of 26.6% [15.5–54.0] of total daily caloric intake and 66.2% [53.0–76.4] of daily NNCs intake in patients receiving propofol. By Day 7, only 47.3% of patients had reached their caloric target, while 45.8% remained below target and 6.9% were above target. The instances of overnutrition were minimal and were often associated with NNCs, particularly propofol. Mortality at Day 28 in patients who received propofol during the first 7 days was 32/117 (27%) versus 23/40 (57%) in those who did not (P < 0.001). Conclusions: Our study emphasizes the significant role of NNCs in the early nutritional intake of ICU patients suffering from ARDS due to COVID-19. These findings highlight the need for careful nutritional management in these patients, with particular consideration given to NNCs. Future research should investigate strategies to optimize nutritional support in this specific population.

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