Feeding intolerance in critically ill patients with COVID-19

Abstract

Background and Aims Early reports suggest significant difficulty with enteral feeding in critically ill COVID-19 patients. This study aimed to characterize the prevalence, clinical manifestations, and outcomes of feeding intolerance in critically ill patients with COVID-19. Methods We examined 323 adult patients with COVID-19 admitted to the intensive care units (ICUs) of Massachusetts General Hospital between March 11-June 28, 2020 who received enteral nutrition. Systematic chart review determined prevalence, clinical characteristics, and hospital outcomes (ICU complications, length of stay, and mortality) of feeding intolerance. Results Feeding intolerance developed in 56% of the patients and most commonly manifested as large gastric residual volumes (83.9%), abdominal distension (67.2%), and vomiting (63.9%). Length of intubation (OR 1.05, 95% CI 1.03-1.08), ≥1 GI symptom on presentation (OR 0.76, 95% CI 0.59-0.97), and severe obesity (OR 0.29, 95% CI 0.13-0.66) were independently associated with development of feeding intolerance. Compared to feed-tolerant patients, patients with incident feeding intolerance were significantly more likely to suffer cardiac, renal, hepatic, and hematologic complications during their hospitalization. Feeding intolerance was similarly associated with poor outcomes including longer ICU stay (median [IQR] 21.5 [14-30] vs. 15 [9-22] days, P <0.001), overall hospitalization time (median [IQR] 30.5 [19-42] vs. 24 [15-35], P <0.001) and in-hospital mortality (33.9% vs. 16.1%, P <0.001). Feeding intolerance was independently associated with an increased risk of death (HR 3.32; 95% CI 1.97-5.6). Conclusions Feeding intolerance is a frequently encountered complication in critically ill COVID-19 patients in a large tertiary care experience and is associated with poor outcomes.

Qualitative and quantitative muscle ultrasound changes in patients with COVID-19–related ARDS

“…In fact, the amount of proteins administered with the nutritional support was significantly lower in non-survivors (see figure 2 ). One possible explanation for such a reduced protein administration might be a higher incidence of intolerance to enteral feeding in non-survivors, which is known to be a marker of a more severe disease state and associated with a worse outcome, especially in the COVID-19 population [62] . No differences were found in the cumulative energy (calorie) deficit, likely because a significant part of the calorie provision came from intravenous lipids from propofol infusion.…”

Long-Term Evolution of Malnutrition and Loss of Muscle Strength after COVID-19: A Major and Neglected Component of Long COVID-19

“…Several factors could explain malnutrition during this acute phase, including marked systemic inflammation driving hypermetabolism and muscle catabolism, and prolonged periods of bedrest driving disuse atrophy. Up to 40% of patients with COVID-19 experience gastrointestinal symptoms ranging from nausea, vomiting, anorexia, diarrhea and abdominal distention, especially in ICU COVID patients [4], which can further deter eating and impact the tolerance of nutritional support [5]. Olfactory and gustatory dysfunction [6] may also contribute to weight loss [7,8].…”

“…Medical teams have become increasingly aware of the importance of multidisciplinary care, taking into account fatigue and functional disability, but nevertheless overlooking the nutritional aspect and the importance of the decrease in muscle strength [1]. Nowadays, muscle weakness and fatigue appear as a frequent complaint among these patients [4,5].…”

Does Route of Full Feeding Affect Outcome among Ventilated Critically Ill COVID-19 Patients: A Prospective Observational Study

“…Only a few studies so far have provided limited data about nutrition support. A USA cohort [ 24 ] revealed that more than half of the participants (56%) presented intolerance to enteral nutrition, which was associated with higher ICU stay and in-hospital mortality, whereas a similar study among intubated patients from Mexico revealed a lower prevalence of intolerance to enteral nutrition—about 32% [ 25 ]. A series of 176 critically ill patients with COVID-19 disease [ 26 ] managed to reach their energy and protein requirements during the first week of admission especially through the use of supplemental parenteral nutrition.…”