(395) Adequacy of Enteral Nutrition in Critically Ill Patients With COVID-19 in Prone Position

Introduction: Historically, there has been hesitancy surrounding the implementation of enteral nutrition (EN) for proned patients due to concerns of intolerance. The COVID-19 pandemic precipitated a rise in invasive mechanical ventilation in the prone position which led to increased prone position EN experience for healthcare professionals. Although previous small-scale studies have demonstrated the safety of EN in the prone position, the current available evidence on the adequacy of EN remains insufficient.

Methods: A retrospective chart review of adult patients (≥18 years old) admitted to the Medical Intensive Care Unit (MICU), Surgical ICU (SICU), Neurological Critical Care Unit (NCCU), and Neurological Intermediate Care Unit (NIMC) at a tertiary teaching hospital in Boston, Massachusetts between April-May 2020. Patients with an EN order ≥ 48 hours with a combined ICU length of stay (LOS) ≥72 hours were eligible for inclusion. Patients < 18 years old at the time of admission, on invasive mechanical ventilation < 24 hours, or without a COVID-19 diagnosis during their ICU stay were excluded.

Results: Of the 309 patients screened, 45 met inclusion criteria, with 30 receiving EN in the prone position and 15 in the supine position. The prone group had an average age of 66±13, average BMI of 31.9±7.2, APACHE III score of 97.6±23.5, median ICU LOS of 19 days, and a male-to-female ratio of 2:3. The supine group demonstrated no significant differences in demographics, with an average age of 64±13 (p=0.63), average BMI of 28.6±7.2 (p=0.05), APACHE III score of 88.5±19.7 (p=0.18), median ICU LOS of 12 days (p=0.33), and a male-to-female ratio of 7:8 (p=0.67). There was no significant difference in the percentage of goal enteral volume received (66.0% prone vs. 57.7% supine [p=0.11]), median days receiving EN (17 vs. 12 [p=0.32]), or calories received (922.4 kcal/d vs. 861.5 kcal/d [p=0.53]).

Conclusions: In critically ill patients receiving mechanical ventilation, there is no significant difference in the percentage of goal enteral feeding volume received or the delivery of calories in the prone vs. supine position. Larger studies are needed to further explore the provision of optimal EN and its associated clinical outcomes in this population.