Nutrition care practice patterns for patients with COVID‐19—A preliminary report

Ansu, Velarie; Papoutsakis, Constantina; Gletsu‐Miller, Nana; Spence, Lisa; Kelley, Kathryn; Woodcock, Lindsay; Wallace, Taylor C.; Steiber, Alison

doi:10.1002/jpen.2106

Cited by 14 publications

(16 citation statements)

References 6 publications

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“…It has been reported that active intervention by a nutritionist/dietitian would be meaningful for patients in the ICU [35], and they might contribute directly to patients' nutrition care or to influence nutrition therapy provided by critical care teams. Their importance has been also reported in less severely ill patients and for prevention of COVID-19 [36,37]. Specialists for nutrition therapy might be needed for active critical care nutrition support.…”

Section: Discussionmentioning

confidence: 96%

Nutrition therapy in the intensive care unit during the COVID-19 pandemic: Findings from the ISIIC point prevalence study

Nakamura

Liu

Katsukawa³

et al. 2022

Clinical Nutrition

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Background Nutrition therapy for Intensive Care Unit (ICU) patients involves complex decision-making, especially during the COVID-19 pandemic. We investigated the use of nutrition therapy in ICU patients with and without COVID-19 infections. Methods Nutrition therapy was evaluated during a world-wide one-day prevalence study focused on implementation of the ABCDEF bundle (A: regular pain assessment, B: both spontaneous awakening and breathing trials, C: regular sedation assessment, D: regular delirium assessment, E: early mobility and exercise, and F: family engagement and empowerment) during the COVID-19 pandemic. Basic ICU and patient demographics including nutrition therapy delivery were collected on the survey day. Physical activity for patients with and without COVID infections was categorized using the ICU mobility scale (IMS). Multivariable regression analysis of nutrition was conducted using ICU parameters. Results The survey included 627 non-COVID and 602 COVID patients. A higher proportion of COVID-19 patients received energy ≥ 20 kcal/kg/day (55% vs. 45%; p=0.0007) and protein ≥1.2 g/kg/day (45% vs. 35%; p=0.0011) compared to non-COVID patients. Enteral nutrition was provided to most COVID patients even with prone positioning (91%). Despite nutrition therapy, IMS was extremely low in both groups; median IMS was 1 in non-COVID patients and 0 in COVID patients. The rate of energy delivery ≥ 20kcal/kg/day was significantly higher in patients with COVID-19 infections in the subgroup of ICU days ≤ 5 days and IMS ≤ 2. Having a dedicated ICU nutritionist/dietitian was significantly associated with appropriate energy delivery in patients both with and without COVID-19 infections, but not with protein delivery. Conclusion During the COVID-19 pandemic, patients with COVID-19 infections received higher energy and protein delivery. Generally low mobility levels highlight the need to optimize early mobilization with nutrition therapy in all ICU patients.

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Section: Discussionmentioning

confidence: 96%

Nutrition therapy in the intensive care unit during the COVID-19 pandemic: Findings from the ISIIC point prevalence study

Nakamura

Liu

Katsukawa³

et al. 2022

Clinical Nutrition

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“…The observed increase in prescribed enteral nutrition from 2020 to 2021 may be, among other causes, due to the increase in malnutrition and need for enteral nutritional support in all age groups as infection increases in the population [ 23 , 24 ]. Patients who are hospitalized with COVID-19 have a higher prevalence of malnutrition than their hospitalized counterparts without COVID-19 [ 25 ]. The parallelism of the prescription of containers and healthcare expenditure is notable, with no significant differences in total costs from 2016 to 2021, as it was not seen either during the previous study [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on Short- and Medium-Term Prescription of Enteral Nutrition in the General Population vs. Older People in the Community of Madrid, Spain

et al. 2022

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We aimed to analyse the impact of COVID-19 during 2020 and 2021 on the prescription of enteral nutritional support and its expenditure in the Community of Madrid, Spain, compared to pre-pandemic data from 2016 in the general population vs. elderly. We analysed official electronic prescriptions of all public hospitals of the Community of Madrid. The population over 75 years of age have the higher prescription of nutritional supplements (p < 0.001 vs. other age groups), with no differences between the 45–64 age group compared to the 65–74 age group (χ2 = 3.259, p = 0.196). The first wave of COVID-19 or the first time there was a real awareness of the virus in Spain is similar in a way to the first peak of prescription of enteral nutrition in March 2020. The second peak of prescription was observed in the over 75 age group in July 2020, being more pronounced in December 2020 and March–April of the following year (F = 7.863, p = 0.041). The last peaks correspond to summer 2021 and autumn of the same year (p = 0.031—year 2021 vs. 2020, p = 0.011—year 2021 vs. 2019), where a relationship between increased prescription of enteral nutrition and COVID-19 cases is observed. High-protein and high-calorie dietary therapies were the most prescribed in patients with or without diabetes. All of this entailed higher cost for the Community of Madrid. In conclusion, COVID-19 significantly affected the prescription of nutritional support, especially in the population over 75 years of age.

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“…Many of them received awake prone therapy, and may potentially suffer from dyspnoea, anosmia and ageusia, which may lead to poor oral intake. 15 EN was started on day 4 of ICU admission in most of these patients. Although they had significantly lower disease severity, their mortality rate was significantly higher than patients first exposed to EN in the initial 2 days of ICU admission.…”

Section: Timing and Feeding Routementioning

confidence: 99%

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

Lew

Wong

et al. 2022

Ann Acad Med Singap

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Introduction: To improve the nutritional care and resource allocation of critically ill patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), we described their characteristics, treatment modalities and clinical outcomes, and compared their nutrition interventions against the American Society for Parenteral and Enteral Nutrition (ASPEN) recommendations. Methods: This was a retrospective observational study conducted in 5 tertiary hospitals in Singapore. Characteristics, treatment modalities, clinical outcomes and nutrition interventions of critically ill patients with SARS-CoV-2 who received enteral and parenteral nutrition were collected between January and May 2020. Results: Among the 83 critically ill patients with SARS-CoV-2, 22 (28%) were obese, 45 (54%) had hypertension, and 21 (25%) had diabetes. Neuromuscular blockade, prone therapy and dialysis were applied in 70% (58), 47% (39) and 35% (29) of the patients, respectively. Refeeding hypophosphataemia and hospital mortality occurred respectively in 6% (5) and 18% (15) of the critically ill patients with SARS-CoV-2. Late enteral nutrition and cardiovascular comorbidities were associated with higher hospital mortality (adjusted relative risk 9.00, 95% confidence interval [CI] 2.25–35.99; 6.30, 95% CI 1.15–34.40, respectively). Prone therapy was not associated with a higher incidence of high gastric residual volume (≥250mL). The minimum caloric (15kcal/kg) and protein (1.2g/kg) recommendations of ASPEN were achieved in 54% (39) and 0% of the patients, respectively. Conclusion: The high obesity prevalence and frequent usage of neuromuscular blockade, prone therapy, and dialysis had considerable implications for the nutritional care of critically ill patients with SARS-CoV-2. They also did not receive adequate calories and protein. More audits should be conducted to refine nutritional interventions and guidelines for this ever-evolving disease. Keywords: COVID-19, critical illness, energy intake, enteral nutrition, nutrition support, protein intake

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Nutrition care practice patterns for patients with COVID‐19—A preliminary report

Cited by 14 publications

References 6 publications

Nutrition therapy in the intensive care unit during the COVID-19 pandemic: Findings from the ISIIC point prevalence study

Nutrition therapy in the intensive care unit during the COVID-19 pandemic: Findings from the ISIIC point prevalence study

Impact of COVID-19 on Short- and Medium-Term Prescription of Enteral Nutrition in the General Population vs. Older People in the Community of Madrid, Spain

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

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