Diversified nutritional support of patients in severe forms of COVID-19

Abstract

Significance: The COVID-19 pandemic, declared by WHO on March 11, 2020, has made significant adjustments to the principles of organizing medical care, including treatment, nutrition and care of patients in infectious hospitals. The disease has different clinical courses: from mild asymptomatic to extremely severe, requiring aggressive medical intervention such as organ replacement therapy to replace vital body functions. [1]
 The spread of viral infection was global, but the pathophysiological aspects of the course of COVID-19 have not been studied enough. The development of ARDS and systemic inflammatory response syndrome as part of the severe course of the disease is accompanied by severe metabolic disorders that require close attention. It is necessary to correct the clinical manifestations of organ dysfunction under severe hypercatabolism. Considerable importance is given to the peculiarities of providing nutritional support to patients using specialized nutritional mixtures to prevent conditions that worsen the prognosis of recovery and survival of patients. [2]
 The target cells of the virus are angiotensin-converting enzyme receptors of the respiratory, nervous, urinary, cardiovascular systems and organs of the gastrointestinal tract. [3] Consequently, the site of the infection at different organs and systems gives rise to the phenomena of respiratory failure and many heterogeneous clinical manifestations of the disease, which can affect all ties in the pathogenesis of nutritional deficiency. Malnutrition is usually due to the mismatch between the intake and consumption of nutrients, micro-and macroelements. [4]
 Aim: To systematize ways in which we provide nutritional support based on the prevalent causes of protein-energy malnutrition, taking into account the patient's individual needs and the extent of respiratory support. We analyzed several papers published by foreign colleagues and our own experience in the Department of Anesthesiology and Intensive Care for Patients with a New Coronavirus Infection COVID-19 at the Russian Academy of Sciences Central Clinical Hospital in Moscow in 2020.