A pragmatic approach and treatment of coronavirus disease 2019 (COVID-19) in intensive care unit

Nutritional profile and outcomes of noncritical hospitalized patients with COVID-19 in a large tertiary hospital in southern Brazil

INTRODUCTION:

Patients with chronic diseases, such as diabetes and cardiovascular diseases, and old age, which are associated with a high risk of malnutrition and worse outcomes, are at a higher risk for developing the severe presentation of COVID-19.

METHODS:

This is an observational and cross-sectional study with a sample defined by convenience. Data were collected in adult inpatient units through information obtained via telephone contact with the patient/companion, records collected by the nursing staff, and medical records, tabulating demographics, body composition, previous illnesses, nutritional diagnoses, diet acceptance, and hospitalization outcomes. The following symptoms were observed: inappetence, smell, dysgeusia, odynophagia, nausea, vomiting, and diarrhea.

RESULTS:

Most deaths occurred after transfer to the intensive care unit (79.6%). Patients with the worst outcome had lower food intake with a cutoff point of 60% for diet acceptance, which seems to be an adequate discriminator between those who survived and those who did not. Gastrointestinal symptoms were significantly associated with food consumption below 60% of the planned goal. The symptoms most associated with lower energy intake were inappetence, dysgeusia, and nausea/vomiting.

CONCLUSIONS:

Reduced caloric intake and the presence of nutritional risk or its appearance during hospitalization seemed to be associated with mortality in patients with COVID-19 admitted outside the intensive care unit.

Characteristics and outcomes of COVID-19 patients assisted by intensivists and nonintensivists

OBJECTIVE:

The aim of this study was to assess the outcomes of critically ill patients with COVID-19 in an intensive care unit seen by a care team formed by intensive and nonintensive physicians and treatment guided by processes and protocols linked to the “choosing wisely” concept, comparing them with similar data recently published.

METHODS:

An observational cohort including adult patients with COVID-19 admitted to the intensive care unit of Hospital Independence between August 2020 and August 2021. Inclusion criteria were 18 years of age or older and there were no exclusion criteria.

RESULTS:

The study included 449 patients, of which 64.1% were referred from the ward, 21.6% from emergency rooms, and 14.2% from another hospital (continuity of attendance). The overall mortality was 48.5%, occurring mainly in the elderly and or those undergoing mechanical ventilation. We did not find any associations between different strata of body mass index and mortality. In the multivariate analysis, the time elapsed between the onset of symptoms and hospital admission, mechanical ventilation, C-reactive protein value at the end of the first week in the intensive care unit, and renal failure were independently associated with mortality. Vaccinated people comprised 8.8% of the sample, with no differences in mortality among the different vaccines, and 13.4% of patients underwent palliative treatment.

CONCLUSIONS:

Patients admitted for acute respiratory syndrome due to SARS-CoV-2 are severe and have a high mortality rate, mainly if submitted to invasive mechanical ventilation. The emergence of acute renal failure marks an especially severe subgroup with increased mortality. Processes and protocols linked to the “choosing-wisely” concept seemed to significantly benefit our intensive care unit since it had a large contingent of nonspecialist physicians.