Impact of nutritional therapy during the first wave of the COVID-19 pandemic in intensive care patients: A retrospective observational study

Obesity decreases energy and protein intake in hospitalized COVID-19 patients undergoing continuous positive airway pressure treatment

Patients with SARS-CoV generally require noninvasive treatments including continuous positive airway pressure (CPAP), and appropriate nutritional therapy. Our hypothesis was that a higher body mass index (BMI) would result in greater respiratory difficulties during CPAP treatment and lead to a reduction in energy and protein intake. The study was conducted prospectively and retrospectively in a Brazilian public hospital. The sample comprised all patients (n = 70) hospitalized in COVID-19 wards and using the Elmo System (ELMO) helmet. To ensure proper nutritional support, the hospital established a standard ELMO diet and questionnaire for estimating dietary adherence. The median length of stay was 11 days (interquartile range, 9-20), and 84.3% of the patients received hospital discharge. The median duration of helmet use was 1.5 days (interquartile range, 1-4). From mid-upper arm circumference adequacy measurements, 35 patients (50%) were classified as being overweight or living with obesity and 36 adult patients (66.7%) were considered living with obesity based on their BMI. The prevalence of overweight elderly patients was 81.3%. The median energy and protein intake adequacy percentages were 65% and 72.5%, respectively. Patients with higher BMIs exhibited lower oxygen flows while wearing the ELMO helmet. Younger age and lower energy and protein intake characterized the obesity group. A correlation between oxygen therapy and food intake in COVID-19 patients undergoing CPAP treatment was observed. Patients with higher BMIs and/or mid-upper arm circumference adequacies were more susceptible to energy and protein intake declines, and patients with obesity presented the lowest intake values.

Dietetic-Led Nutrition Interventions in Patients with COVID-19 during Intensive Care and Ward-Based Rehabilitation: A Single-Center Observational Study

Background: In this study, a report of dietitian-led nutrition interventions for patients with COVID-19 during ICU and ward-based rehabilitation is provided. As knowledge of COVID-19 and its medical treatments evolved through the course of the pandemic, dietetic-led interventions were compared between surge 1 (S1) and surge 2 (S2). Methods: A prospective observational study was conducted of patients admitted to the ICU service in a large academic hospital (London, UK). Clinical and nutrition data were collected during the first surge (March–June 2020; n = 200) and the second surge (November 2020–March 2021; n = 253) of COVID-19. Results: A total of 453 patients were recruited. All required individualized dietetic-led interventions during ICU admission as the ICU nutrition protocol did not meet nutritional needs. Feed adjustments for deranged renal function (p = 0.001) and propofol calories (p = 0.001) were more common in S1, whereas adjustment for gastrointestinal dysfunction was more common in S2 (p = 0.001). One-third of all patients were malnourished on ICU admission, and all lost weight in ICU, with a mean (SD) total percentage loss of 8.8% (6.9%). Further weight loss was prevented over the remaining hospital stay with continued dietetic-led interventions. Conclusions: COVID-19 patients have complex nutritional needs due to malnutrition on admission and ongoing weight loss. Disease complexity and evolving nature of medical management required multifaceted dietetic-led nutritional strategies, which differed between surges.

Nutrition during extracorporeal life support: A review of pathophysiological bases and application of guidelines

BACKGROUND

Patients on extracorporeal life support (ECLS), either for respiratory or cardiac support, are at high risk of malnutrition; guidelines on nutrition in critical care have not incorporated solid evidence regarding these settings. The aim of this narrative review is to gather the available evidence in the existing literature and transpose general principles to the ECLS population.

METHODS

A literature review of observational and interventional studies on nutrition during ECLS, and evaluation of nutrition guidelines in this perspective.

RESULTS

Nutrition is paramount for improving outcomes in ECLS, as well as in critically ill patients. The caloric needs during ECLS can vary according to the severity of the clinical state, sedation, paralysis, and temperature stability. Precise evaluation of energy expenditure by indirect calorimetry is difficult because ECLS is a system dedicated to removing carbon dioxide; however, modified equations composed of carbon dioxide values taken from the membrane lung are available. Guidelines suggest starting early enteral nutrition (EN) with a hypocaloric (70%-80% of the needs) strategy, also in acute states such as septic or cardiogenic shock. Moreover, EN, despite previous concerns, is feasible in prone position, an increasingly adopted strategy during mechanical ventilation. The catabolic state is maximal in these patients, causing a protein and muscular reduction. Therefore, adequate protein delivery should be guaranteed by administering a high protein intake of up to 2 g/kg/day.

CONCLUSIONS

Studies on nutrition tailored to ECLS patients are warranted. Early hypocaloric EN with high protein intake, tailored on indirect calorimetry, may be the most appropriate option.