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Relation between nutrition therapy in the acute phase and outcomes of ventilated patients with COVID-19 infection: a multicenter prospective observational study.
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- المؤلفون: Nakamura, Kensuke1 ; Hatakeyama, Junji2; Liu, Keibun3; Kanda, Naoki1; Yamakawa, Kazuma4; Nishida, Takeshi5; Ohshimo, Shinichiro6; Inoue, Shigeaki7; Hashimoto, Satoru8; Maruyama, Shuhei9; Kawakami, Daisuke10; Ogata, Yoshitaka11; Hayakawa, Katsura12; Shimizu, Hiroaki13; Oshima, Taku14; Fuchigami, Tatsuya15; Nishida, Osamu16
- المصدر:
American Journal of Clinical Nutrition. Apr2022, Vol. 115 Issue 4, p1115-1122. 8p. 1 Diagram, 3 Charts, 1 Graph.
- الموضوع:
- معلومة اضافية
- نبذة مختصرة :
Background Optimal nutrition therapy has not yet been established for the acute phase of severe coronavirus disease 2019 (COVID-19) infection. Objectives We aimed to examine the effects of nutrition delivery in the acute phase on mortality and the long-term outcomes of post-intensive care syndrome (PICS). Methods A multicenter prospective study was conducted on adult patients with COVID-19 infection requiring mechanical ventilation during an intensive care unit (ICU) stay. Daily total energy (kcal/kg) and protein (g/kg) deliveries in the first week of the ICU stay were calculated. The questionnaire for PICS evaluation was mailed within a median of 6 mo after hospital discharge. The primary outcome was in-hospital mortality, and secondary outcomes were the PICS components of physical impairment, cognitive dysfunction, and mental illness. Results Among 414 eligible patients, 297 who received mechanical ventilation for 7 d or longer were examined. PICS was evaluated in 175 patients among them. High protein delivery on days 4–7 correlated with a low in-hospital mortality rate. In contrast, high protein delivery on days 1–3 correlated with physical impairment. A multivariate logistic regression analysis adjusted for age, sex, BMI, and severity revealed that average energy and protein deliveries on days 4–7 correlated with decreased in-hospital mortality (OR: 0.94; 95% CI: 0.89, 0.99; P = 0.013 and OR: 0.40; 95% CI: 0.17, 0.93; P = 0.031, respectively). Nutrition delivery did not correlate with PICS outcomes after adjustments. In the multivariate regression using a restricted cubic spline model, in-hospital mortality monotonically decreased with increases in average nutrition delivery on days 4–7. Conclusions In patents with COVID-19 on mechanical ventilation for ≥7 d, nutrition delivery in the late period of the acute phase was monotonically associated with a decrease in in-hospital mortality. Adequate protein delivery is needed on days 4–7. This trial was registered at https://www.umin.ac.jp as UMIN000041276. [ABSTRACT FROM AUTHOR]
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