Nutritional therapy in Covid-19 critically ill patients

Abstract

Rationale: Adequate nutritional support in hospitalized patients, is not only essential to maintain and recover the nutritional status of patients, but also, is important for maintaining the mucosa of the gastrointestinal tract, reducing bacterial translocation, reducing the risk of infections and, consequently, decreasing length of hospital stay. Methods: A descriptive, cross-sectional and retrospective study was carried out with 370 patients of both sexes, between 18 and 92 years old and under prescription of exclusive enteral nutritional therapy, admitted to two private hospitals in the city of São Paulo from January to December 2019. Secondary data was collected from the records of the multidisciplinary nutritional therapy team and used to state the main reasons for discontinuing the Enteral Nutrition infusion in patients who received less than 80% of their prescribed volume. Results: It was found that 18% of patients with exclusive enteral nutritional therapy received less than 80% of their prescribed volume. From these patients, 42% were related to failure to document the infused volume in the patient's medical record, that is, the patient received the appropriate volume, but there was no record to evidence so. Of the remaining patients, 20% presented hemodynamic instability, 12% problems related to probe / gastrostomy, 11% fasting for procedure, 10% gastrointestinal changes and 5% fasting for exam. Conclusion:In the present study, the main complications refer to the failure of data recording by the nursing team. Thus, the continuing education of professionals who belong to the multidisciplinary team is fundamental to guarantee the success of nutritional therapy and better clinical outcome for the patients. References: 1-Figueredo LP. Complications of nutritional therapy enteral and associated factors in hospitalized patients [Dissertation].

A longitudinal study to determine if all critically ill patients should be considered at nutrition risk or is there a highly accurate screening tool to be adopted?

“…Sample size calculation estimated 393 patients based on the difference in NUTRIC scores between survivors (5 [3][4][5][6]) and nonsurvivors (6 [5-7]), as observed in the study by Vries et al, considering 80% power and 5% significance level and a survivors/nonsurvivors ratio of 0.25. 17 An additional 20% was included to account for potential losses to follow-up and adjustments in a multivariate model, resulting in a final estimated sample size of 472 patients.…”

“…2 Identifying critically ill patients who would benefit from early and aggressive nutrition therapy is challenging because traditional methods for assessing the nutrition status of hospitalized patients are often impractical in the ICU setting. 3 Following recommendations from prominent national and international societies, [4][5][6] the first step in the nutrition care process requires using a validated screening tool, with adequate validity, reliability, sensitivity, specificity, and positive predictive value (PPV) for identifying patients at high nutrition risk. 7 Heyland et al proposed that the nutrition risk of critically ill patients should not be seen as the risk of malnutrition, given that the inflammatory response to stress and the consequent protein catabolism affect all critically ill patients.…”

“…Subsequently, Rahman and colleagues validated the tool without interleukin-6 measurement and demonstrated that the modified NUTRIC (mNUTRIC) performed similarly in predicting clinical outcomes and demonstrating the beneficial impact of adequate nutrition therapy on such outcomes in those patients classified as at nutrition risk. 9 The American Society for Parenteral and Enteral Nutrition (ASPEN) 4 and the Brazilian Society of Parenteral and Enteral Nutrition (BRASPEN) 5 recommend the use of the NUTRIC 8 or the Nutritional Risk Screening (NRS-2002) 10 as tools for screening nutrition risk in the ICU. On the other hand, the European Society of Clinical Nutrition and Metabolism (ESPEN) recommends that all patients with ICU stay ≥48 h should be considered at nutrition risk because of the intense catabolism related to the inflammatory response observed in critically ill patients that makes malnutrition development unavoidable.…”

Determination of glycaemic response to the consumption of two specialised formulas for glycaemic control

“…In this sense, it is increasingly evident that glycaemic control is essential. The guidelines of the world's leading nutritional therapy societies for diabetes, as well as for critically ill patients, recommend the use of specialised oral and/or enteral formula for glycaemic control, due to its lower impact on blood glucose (1,2,(7)(8)(9) . These recommendations are based on studies that demonstrate benefits in reducing postprandial blood glucose, the need for insulin application, low blood glucose episodes, and, consequently, glycaemic variability.…”

“…In this sense, it is increasingly evident that glycaemic control is essential. The guidelines of the world’s leading nutritional therapy societies for diabetes, as well as for critically ill patients, recommend the use of specialised oral and/or enteral formula for glycaemic control, due to its lower impact on blood glucose (1,2,7–9) .…”