Barriers to nutrition therapy in the critically ill patient with COVID‐19

Abstract

Background Coronavirus disease 2019 (COVID‐19) has created challenges for intensivists, as high ventilatory demands and prolonged hypermetabolism make it difficult to sustain nutrition status. The purpose of this survey was to determine current practices in nutrition therapy and identify barriers to its delivery. Methods A survey about delivering nutrition therapy to critically ill patients with COVID‐19 was sent to clinicians at academic and community hospitals from September to December 2020. Results Of 440 who viewed the survey, 199 (45%) completed the questionnaire. Respondents were composed of 30%, physicians and 70% registered dietitians, with 51% representing community programs, 43% academic institutions, and 6% Veterans Affairs centers. Half (49%) had protocols for managing critically ill patients with COVID‐19, and 21% had a protocol for nutrition therapy. Although most respondents (83%) attempted to feed by the intragastric route, only 9% indicated that energy/protein needs were met. The biggest barriers to delivery of enteral nutrition (EN) involved the patients unpredictable clinical course and fear of aspiration given the lack of respiratory reserve. Intensivists were reluctant to add supplemental parenteral nutrition (PN) because of perceived lack of benefit. Conclusion The survey results would suggest that strategies for nutrition therapy based on the intragastric infusion of EN are unsuccessful in meeting the energy/protein needs of critically ill patients with COVID‐19. It is likely these barriers exist in providing nutrition to non‐Covid‐19 critically ill patients. Intensivists need protocols that optimally deliver intragastric EN, consider early postpyloric infusion, and address adding supplemental PN in a deteriorating nutrition status.

Abordagem nutricional em pessoas diagnosticadas com COVID-19 hospitalizadas em Unidades de Terapia Intensiva: uma revisão integrativa

“…Al Suliman et al (2022) demonstraram que determinadas barreiras são enfrentadas para o fornecimento de uma terapia nutricional adequada, o que prejudica o fornecimento de energia, de proteínas e demais nutrientes ao paciente. Dentre as barreiras mais citadas pelos profissionais envolvidos no estudo, o risco de aspiração da NE, os riscos de uma manutenção prolongada da NP e a evolução de forma abrupta dos pacientes foram as mais citadas.…”

The Effects of Enteral Nutrition in Critically Ill Patients with COVID-19: A Systematic Review and Meta-Analysis

“…Despite the significant complications associated with COVID-19, it would appear that only limited attention has been given to nutrition therapy as part of the broader supportive care for the patients [ 18 ]. However, enteral nutrition provision presents its challenges, including the potential for adverse reactions, such as abdominal distention, diarrhoea and regurgitation [ 14 ].…”

Nutrition support practices for critically ill patients with severe acute respiratory syndrome coronavirus-2: A multicentre observational study in Singapore

“…Previous studies have identified barriers in providing nutrition to this vulnerable group, including unpredictable clinical courses and fear of aspiration. 3 In this regard, we recognised that audit of local practices would make clinicians aware of the management gap, if any. There is currently only 1 local study (single-centre case series of 8 patients) that described the nutritional care of SARS-CoV-2 critically ill patients.…”