ABSTRACT
Background: The prone position (PP) used in the treatment of critically ill patients infected with SARS-CoV-2, may be a barrier to enteral nutrition (EN). This study aimed to analyze the effectiveness and complications of EN in the PP, as well as clinical outcomes. Methods: Prospective cohort study with patients in EN and coronavirus disease 2019 (COVID-19), on mechanical ventilation (MV), which whom needed or not PP. Gastrointestinal intolerances (GII) related to PP were evaluated, and correlated with possible confounding factors. EN, days on MV, Intensive Care Unit (ICU) length of stay, hospital length of stay, ventilator-associated pneumonia (VAP) and mortality were analyzed. The data were evaluated daily and compared prone group (PG=57) and supine group (SG=69). Results: The PP was associated with GII (P=0.000) and presented in 32 patients (26,44%) with no difference among groups. Association between epinephrine (P=0.003), vasopressin (P=0.018), and GII was observed. There was no difference between the total volume of enteral nutrition (TVEN) infused in the groups. However, the mean EN infused for the days when the patient was on PP was (70.0% ± 31.5) and for the days in supine position was (74.8% ± 27.3), P= 0.006. The PG had a longer time on MV (P=0.005) and ICU (P=0.003) and PP was associated with VAP (P=<0.001). The infused TVEN showed no association with VAP (P=0.09). Conclusion: PP was a determining factor in GII and proved to be a risk factor for VAP, but the EN protocol seems to have ensured an adequate EN supply in PP and be a safe alternative.
ABSTRACT
Introduction: The 2019 coronavirus disease pandemic (COVID-19) overloads hospitalizations in intensive care units (ICUs) around the world and its severe form is a complex disease that is still being understood. Due to the lack of direct evidence in patients with SARS-CoV-2 infection, guidelines for nutritional management have been based on evidence from critically ill patients in general. Thus, it is known that intense metabolic stress and malnutrition precede the appearance of Beau's lines. This is the case report of a 58-year-old man with the severe form of COVID-19 hospitalized for 33 days in the ICU and who presented the Beau´s lines after 4 months of discharge, even with the infusion of nutritional therapy following the current recommendations for the critical period of the disease.
Introducción: La pandemia de la enfermedad por coronavirus de 2019 (COVID-19) sobrecarga las hospitalizaciones en unidades de cuidados intensivos (UCI) en todo el mundo y su forma grave es una enfermedad compleja que aún se está comprendiendo. Debido a la falta de evidencia directa en pacientes con infección por SARS-CoV-2, las pautas para el manejo nutricional se han basado en la evidencia de pacientes críticos en general. Así, se sabe que el estrés metabólico intenso y la desnutrición preceden a la aparición de las líneas de Beau. Este es el caso clínico de un hombre de 58 años con la forma grave de COVID-19 hospitalizado durante 33 días en la UCI y que presentó las líneas de Beau después de 4 meses del alta, incluso con la infusión de terapia nutricional prescrita en consecuencia a las recomendaciones actuales para el periodo crítico de la enfermedad.