Challenges in offering full enteral nutritional therapy to patients with Covid-19 admitted to an Icu of a particular hospital in the city of São Paulo, Brazil

Abstract

Rationale: Delivery of adequate enteral nutrition is important in critically ill patients. Underfeeding is not uncommon, which could result in malnutrition and poor clinical outcomes. Volume-based feeding has been shown to be a safe method to make up for the enteral nutrition missed due to daily interruptions. [1][2][3] This study investigated the differences in energy and protein provision of patients on enteral feeding under the implementation of volume-based feeding protocol in an intensive care unit in Hong Kong. Methods: Forty patients who were on enteral feeding with episodes of feeding interruptions from May 2019 to March 2020 were included in this study. Patients on supplemental parenteral nutrition were excluded. The intervention group (20 patients) adopted volume-based feeding protocol while the control group (20 patients) did not. The two groups were compared in terms of percentages of energy and protein loss due to feeding interruptions and the percentages of energy and protein goals met after feeding started. Independent t-test at a confidence interval of 95% was used to compare the two groups. Results: The duration of feeding interruption per ICU day between the intervention and control groups were not different (2.9 ±2.1 hours compared with 4.0±2.8 hours, p ¼ 0.139). The daily energy requirements (1543±176 kcal compared with 1603±187 kcal, p¼0.305) and protein requirements (82±11g compared with 85±11g, p¼0.410) were also not significantly different. The intervention group had significantly less energy loss (9.1±7.8% compared with 16.0±11.5%, p ¼0.032) and less protein loss (8.0±7.4% compared with 14.0±10.2%, p¼0.040) due to feeding interruptions. The intervention group met higher energy goals (84.3±13.4% compared with 79.1±16.7%, p¼0.278) and higher protein goals (74.0±16.2% compared with 70.1±15.8%, p¼0.449) after feeding started, though the differences were not statistically significant. Conclusion: Volume-based feeding protocol significantly lowers energy and protein loss due to feeding interruptions for enterally-fed patients in ICU. Further investigations are needed in order to achieve higher energy and protein adequacy in this patient population.