Invasive Mechanical Ventilation and Nutrition Intake in Association with Serious Outcomes Among COVID-19 ICU Patients

Download or read book Invasive Mechanical Ventilation and Nutrition Intake in Association with Serious Outcomes Among COVID-19 ICU Patients written by Yan Wang and published by . This book was released on 2021 with total page 27 pages. Available in PDF, EPUB and Kindle. Book excerpt: Worse clinical outcomes have been reported among critically ill COVID-19 patients who are admitted to an inpatient intensive care unit (ICU), especially those who require invasive mechanical ventilation (IMV). Patients on IMV do not receive any food or medication by mouth, during which their energy and protein needs are dependent on enteral nutrition (EN) and propofol lipid emulsion delivery (and parenteral nutrition if needed). Underfeeding throughout the ICU stay has been reported, while overfeeding due to propofol delivery is also a concern, which were both reported to be harmful to critically ill patients. However, there are limited data on the nutrition intake of COVID-19 patients during IMV and the association with in-hospital mortality. Objectives: In this study, we examined whether IMV is associated with higher mortality and longer ICU length of stay in critically ill ICU patients admitted with COVID-19. We calculated the energy and protein intake from EN and the lipid emulsion for propofol and also evaluated the associations with in-hospital mortality. We conducted a hospital-based retrospective study, using chart review of electronic medical records among COVID-19 patients admitted to an ICU at Harborview Medical Center (HMC) in Seattle, Washington, between March 5, 2020, through October 31, 2020. Multivariable logistic regression models were used to assess the associations between IMV and in-hospital mortality. Among those who survived to hospital discharge, multivariable linear regression was used to estimate the associations between IMV and ICU length of stay. Among those who received IMV during their hospital stay, we used multivariable logistic regression to estimate the associations between the nutrition intake during IMV and in-hospital mortality. Ninety-five patients were included in the chart review. The mean age was 60.9 [standard deviation (SD): 16.1] years and 78.9% were men. About half (50.5%) received IMV during hospitalization; 33.7% died prior to hospital discharge. After adjustment for demographics, the odds of in-hospital mortality was 3.28 (95% CI: 1.12, 9.59) times higher among patients who received IMV than those who did not (p = 0.03). The association was slightly attenuated after further adjustment for comorbidities [adjusted odds ratio (aOR) = 3.01 (95% CI: 0.97, 9.39), p = 0.06], prior medication use [aOR = 3.04 (95% CI: 0.96, 9.58), p = 0.06], and Sequential Organ Failure Assessment (SOFA) score [aOR = 2.92 (95% CI: 0.84, 10.15), p = 0.09]. Among the sixty-three patients who survived to hospital discharge, we found that patients receiving IMV were in the ICU 19.4 days longer (95% CI: 11.6, 27.3), than those who did not receive IMV after adjustment for demographics, comorbidities, prior medication use, and SOFA score (p