Nutritional priorities in patients with severe COVID-19

Abstract

Purpose of reviewThe COVID-19 pandemic has altered the profile of critical care services internationally, as professionals around the globe have struggled to rise to the unprecedented challenge faced, both in terms of individual patient management and the sheer volume of patients that require treatment and management in intensive care. This review article sets out key priorities in nutritional interventions during the patient journey, both in the acute and recovery phases. Recent findingsThe current review covers the care of the acutely unwell patient, and the evidence base for nutritional interventions in the COVID-19 population. One of the biggest differences in caring for critically ill patients with acute respiratory failure from COVID-19 is often the time prior to intubation. This represents specific nutritional challenges, as does nursing patients in the prone position or in the setting of limited resources. This article goes on to discuss nutritional support for COVID-19 sufferers as they transition through hospital wards and into the community.

Statistical analysis plan for the replacing protein via enteral nutrition in a stepwise approach in critically ill patients (REPLENISH) randomized clinical trial

“…Long stay in the ICU, especially for intubated and ventilated patients, contributes to further malnutrition, loss of skeletal muscle mass, and disability. Though early and adequate enteral nutrition would be thought to mitigate these challenges and prevent gastrointestinal dysfunction [ 33 , 34 ], it has the potential for adverse reactions like abdominal distention, diarrhea, regurgitation, and overfeeding [ 35 ]. Thus, the proper timing of optimal nutrients needed to meet the energy and protein requirements in critically ill patients with COVID-19 is debatable [ 35 ].…”

Statistical Analysis Plan for the Replacing Protein via Enteral Nutrition in a Stepwise Approach in Critically Ill Patients (REPLENISH): A Randomized Clinical Trial

“…Though early and adequate enteral nutrition would be thought to mitigate these challenges and prevent gastrointestinal dysfunction, [32,33] it has the potential for adverse reactions like abdominal distention, diarrhea, regurgitation, and overfeeding. [34] Thus, the proper timing of optimal nutrients needed to meet the energy and protein requirements in critically ill patients with COVID-19 is debatable. [34] We will conduct a subgroup analysis based on COVID status at baseline and assess the effect of protein intake on outcome.…”

“…[34] Thus, the proper timing of optimal nutrients needed to meet the energy and protein requirements in critically ill patients with COVID-19 is debatable. [34] We will conduct a subgroup analysis based on COVID status at baseline and assess the effect of protein intake on outcome. We will conduct a similar analysis to that of the main trial.…”

Association between protocol change to a higher‐protein formula with lower energy targets and nutrient delivery in critically ill patients with COVID‐19: A retrospective cohort study

“…[4][5][6][7] Because patients with severe COVID-19 infection present with additional challenges in relation to nutrition therapy, concern arose that these patients risked being overfed. 14 For example, prolonged periods of low tidal volume, or "lung protective" ventilation may cause many patients to receive considerable amounts of sedative drugs. 15 Because the intravenous sedative drug propofol is a lipid emulsion, this may add an additional 20-30 kcal/h and risk administering excessive energy and/or insufficient protein.…”

“…International guidelines recommend a gradual and incremental approach to the delivery of energy during the first 5–7 days of admission to the ICU, with suggested energy targets varying from 15 to 30 kcal/kg/day of actual body weight (ABW) for patients with a normal body mass index (BMI) and an adjusted body weight for patients with obesity 4–7 . Because patients with severe COVID‐19 infection present with additional challenges in relation to nutrition therapy, concern arose that these patients risked being overfed 14 . For example, prolonged periods of low tidal volume, or “lung protective” ventilation may cause many patients to receive considerable amounts of sedative drugs 15 .…”