Effect of parenteral nutrition in oxygen escalation/de-escalation in SARS-CoV-2 infected patients who are pre-intubation: A multicenter, observational study

Abstract

Background & aims: SARS-CoV-2 infection includes a variety of gastrointestinal manifestations along with the usual viral symptoms of malaise and myalgias. The objective of this study was to determine if intravenous parenteral nutrition (PN) affected the risk of intubation in SARS-CoV-2 patients who were dependent on non-invasive ventilation. Methods: Retrospective, multicenter case-control study which analyzed oxygen requirements for 1974 adults with SARS-CoV-2, who were admitted to the local public hospital system between March 1 and May 17, 2020. Relevant baseline biomarkers were studied over 5 days. The main outcome was an escalation or de-escalation of oxygen requirements relative to the exposure of PN. Results: 111 patients received PN while on non-invasive ventilation. Patients who received PN had a significantly lower odds (p < 0.001) of oxygen escalation in comparison to their control group counterparts (OR ¼ 0.804, 95% CI 0.720, 0.899) when matched for age, body mass index, Charlson comorbidity index, and gender. Conclusion: Initiating PN in the setting of non-invasive ventilation of SARS-CoV-2 infected patients was significantly associated with a lower odds of oxygen escalation. PN does not independently exacerbate oxygen requirements in SARS-CoV-2 infected pre-intubated patients.

COVID-19: Lessons on malnutrition, nutritional care and public health from the ESPEN-WHO Europe call for papers

“…Conversely, in a study from the United States, intolerance to enteral nutrition in ICU was associated with nutritional complications including higher risk of malnutrition, higher risk of organ failure and overall mortality [109]. Also in the ICU setting [110], parenteral nutrition in patients receiving non-invasive ventilation was per se associated with lower odds of oxygen escalation. Consistent with high prevalence of malnutrition in COVID-19 patients with overweight and obesity, and with high risk of developing malnutrition during the course of COVID-19 [2], most of the above reports on nutritional treatment included large subgroups of patients with overweight and obesity.…”

Parenteral nutrition in SARS-CoV-2 patients on non-invasive ventilation: A reply - Letter to the editor

“…We were quite certainly pleased with the letter sent by Quintero et al regarding our work entitled "Effect of parenteral nutrition in oxygen escalation/de-escalation in SARS-CoV-2 infected patients who are pre-intubation: A multicenter, observational study [1]." Many important factors, including limitations on the research methods and techniques, were brought up by Quintero et al We felt it important to bring up a few matters to clarify the purpose of our study and our intention with the publication.…”

Nutrition therapy during noninvasive ventilation: oral or enteral?

“…Despite this, it avoids the respiratory compromise concerns presented with oral and enteral routes. In a retrospective study of 1974 patients, those who received parenteral nutrition had a significantly lower odds of oxygen escalation in comparison to the control group when receiving NIV preintubation [odds ratio (OR) = 0.804, 95% confidence interval (95% CI) 0.720–0.899, P < 0.001] [61 ▪ ]. Supplemental parenteral nutrition may also be considered [62].…”