ESPEN 2022 Abstract Submission

Topic: Critical care

Abstract Submission Identifier: ESPEN22-ABS-1563

THE EFFECT OF PROTEIN ENRICH NUTRITION ON DIAPHRAGM FUNCTION IN MECHANICALLY VENTILATED PATIENTS

E. Uyar^*, ¹, H. Yagmurdur ¹, S. Yamanyar ¹, Y. Güdek ¹, M. Dal ¹, A. Cosar ¹

¹Department of Anesthesia and Intensive Care, Gulhane Education Research Hospital, Ankara, Türkiye

Rationale: Proteins are one of the most important parts of enteral nutrition therapy in critically ill patients.Our primary aim is to demonstrate the effect of high protein on diaphragm muscle thickness to the target of 2.0 g/kg/day, our secondary aim is to evaluate the correlation of diaphragm thickness fraction with rectus femoris muscle thickness in high protein patients.

Methods: This prospective,randomized study included 49 mechanically ventilated patients.The patients were randomly divided into a standard protein(n=24,1.2g/kg/day)group and high protein group(n=25,2.0 g/kg/day) using a computer-generated list.Thickness of rectus femoris(TRF ),thickness of peak inspiratory diaphragm(Tdi,pi), thickness of end expiratory diaphragm(Tdi,ee) were measured by ultrasonography.Thickness fraction of diaphragm(TFdi)was calculated.Data analysis was performed using IBM SPSS 25.0 and MedCalc 15.8 statistical package programs.Relationships between variables were evaluated with Spearman's rho Correlation test. 

Results: A total of 49 patients were included.There was no significant difference in demographic data.

According to ultrasonographıc measurements of baseline values, there were not statistically differences(T_RFp=0.774,TF_di p=0.418,T_di,ee p=0.726,T_di,pi p=0.690,respectively).

A significant difference was found in the measurements of T_di,pi made on the 3rd day and after.İn the HP group,the medianT_di,pi were higher compared to the SP group(p<0.05).

A statistically significant difference was found in the high protein patient group in the T_di,ee measurements performed on the 3,5and 7days(p<0.05).In the HP group,T_di,ee were higher to compared with SP group.

When the TF_di was compared between groups,a statistically significant difference was found in the HP group at 3,5,7 and 15 days(p<0.05).In the HP group,TF_di were higher to compared with SP group.

When both groups were compared,a statistically significant difference was found in theT_RF measurements in the HP group at 5,7 and 15 days.T_RF measurements were higher in the high protein group compared to the standard protein group(p<005).

In HP group, statistically significant correlations were found betweenT_RF and TF_di at the 3^th day(rho=0.429,p=0.032).At these time points,T_RF and TF_di were similarly correlated in the high protein group(rho=0.408,p=0.043).When the 28-day ICU mortality was examined,no significant difference was found between the groups(p> 0.5).

Conclusion: Diaphragmatic USG is a method to detect diaphragmatic dysfunction and to assess atrophy in mechanically ventilated patients.This study proved that diaphragmatic muscle thıcknesses were higher in patients who received 2 g/kg/day protein supplement, and that the diaphragm thickness fraction was better than patients who received 1.2 g/kg/day protein.İt was determined that the diaphragm thickness fraction increased significantly who were provided with 2 g/kg/day protein support compared with standart group.A correlation was found between T_RF and TF_di in critically ill patients in high protein group.Although weaning from mechanical ventilation was not evaluated in this study, randomized controlled studies are needed on weaning from mechanical ventilation with protein-rich enteral nutrition.

Disclosure of Interest: None Declared

Keywords: Diaphragm Function, Intensive Care Unit, Protein Enrich Nutrition, Rectus Femoris Thickness