Effects of early standardized enteral nutrition on preventing acute muscle loss in the acute exacerbation of chronic obstructive pulmonary disease patients with mechanical ventilation

doi:10.5847/wjem.j.1920-8642.2023.046

Abstract

Abstract:

BACKGROUND: To investigate the effects of early standardized enteral nutrition (EN) on the cross-sectional area of erector spine muscle (ESMcsa), plasma growth differentiation factor-15 (GDF-15), and 28-day mortality of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with invasive mechanical ventilation (MV).

METHODS: A total of 97 AECOPD patients with invasive MV were screened in the ICUs of the First People's Hospital of Lianyungang. The conventional EN group (stage I) and early standardized EN group (stage II) included 46 and 51 patients, respectively. ESMcsa loss and GDF-15 levels on days 1 and 7 of ICU admission and 28-day survival rates were analyzed.

RESULTS: On day 7, the ESMcsa of the early standardized EN group was significantly higher than that of the conventional EN group, while the plasma GDF-15 levels were significantly lower than those in the conventional EN group (ESMcsa: 28.426±6.130 cm² vs. 25.205±6.127 cm²; GDF-15: 1661.608±558.820 pg/mL vs. 2541.000±634.845 pg/mL; all P<0.001]. The 28-day survival rates of the patients in the early standardized EN group and conventional EN group were 80.40% and 73.90%, respectively (P=0.406).

CONCLUSION: ESMcsa loss in AECOPD patients with MV was correlated with GDF-15 levels, both of which indicated acute muscular atrophy and skeletal muscle dysfunction. Early standardized EN may prevent acute muscle loss and intensive care unit-acquired weakness (ICU-AW) in AECOPD patients.

Key words: Acute exacerbation of chronic obstructive pulmonary disease, Enteral nutrition, Cross-sectional area, Erector spine muscle, Growth differentiation factor-15, Intensive care unit-acquired weakness (ICU-AW), Prognosis

Yue Li, Yong-peng Xie, Xiao-min Li, Tao Lu. Effects of early standardized enteral nutrition on preventing acute muscle loss in the acute exacerbation of chronic obstructive pulmonary disease patients with mechanical ventilation[J]. World Journal of Emergency Medicine, 2023, 14(3): 193-197.

Figures/Tables 3

Table 1.

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Indicators	Conventional EN group (n=46)	Early standardized EN group (n=51)	t/χ²	P-value
Baseline characteristics
Age, years	65.49±9.28	64.32±10.23	0.587	0.558
Male/total	28/46	33/51	0.391	0.696
Weight, kg	61.22±10.41	62.87±9.68	0.809	0.431
Body mass index, kg/m²	24.32±3.32	25.13±3.74	1.123	0.264
Glasgow Coma Scale	13.54±1.33	13.32±1.56	0.743	0.459
Sequential Organ Failure Assessment	8.95±3.56	8.79±3.73	0.216	0.830
APACHE II	15.75±3.43	16.94±4.23	1.512	0.134
PaO₂, mmHg	108.24±24.32	103.54±21.53	1.010	0.315
PaCO₂, mmHg	83.32±14.27	85.42±15.38	0.695	0.488
Smoking history	23/46	21/51	0.872	0.383
Comorbidities
Coronary artery disease	8/46	7/51	0.499	0.618
Diabetes mellitus	6/46	7/51	0.098	0.922
Hypertension	10/46	8/51	0.766	0.444
Liver cirrhosis	3/46	2/51	0.578	0.563
Mechanical ventilation
Tidal volume, mL/kg	7.54±2.34	7.32±2.29	0.468	0.641
PEEP, cmH₂O	6.15±2.32	6.32±1.92	0.395	0.694
Driving pressure, cmH₂O	13.12±3.19	13.23±3.31	0.166	0.868
Plateau pressure, cmH₂O	24.63±3.23	24.35±3.76	0.391	0.696
Static lung compliance, mL/cmH₂O	46.23±12.27	45.39±15.31	0.296	0.768
Dynamic lung compliance, mL/cmH₂O	37.23±5.29	38.36±4.43	1.144	0.255
FiO₂	0.45±0.12	0.43±0.14	0.751	0.454