Energy expenditure and feeding practices and tolerance during the acute and late phase of critically ill COVID-19 patients

Lakenman, P.L.M.; Hoven, B. van der; Schuijs, J.M.; Eveleens, Renate; Bommel, Jasper van; Olieman, Joanne; Joosten, Koen

doi:10.1016/j.clnesp.2021.03.019

Cited by 32 publications

(77 citation statements)

References 53 publications

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“…Therefore, upon ICU admission, nutritional assessment is mandatory. An individualized approach including indirect calorimetry is recommended, because persistent hypermetabolism was observed in these patients [ 130 , 131 ].…”

Section: Tailoring Mnt To the Individual Patient’s Needsmentioning

confidence: 99%

Nutrition in the Intensive Care Unit—A Narrative Review

Hill

Elke²,

Weimann

2021

Nutrients

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Background: While consent exists, that nutritional status has prognostic impact in the critically ill, the optimal feeding strategy has been a matter of debate. Methods: Narrative review of the recent evidence and international guideline recommendations focusing on basic principles of nutrition in the ICU and the treatment of specific patient groups. Covered topics are: the importance and diagnosis of malnutrition in the ICU, the optimal timing and route of nutrition, energy and protein requirements, the supplementation of specific nutrients, as well as monitoring and complications of a Medical Nutrition Therapy (MNT). Furthermore, this review summarizes the available evidence to optimize the MNT of patients grouped by primarily affected organ system. Results: Due to the considerable heterogeneity of the critically ill, MNT should be carefully adapted to the individual patient with special focus on phase of critical illness, metabolic tolerance, leading symptoms, and comorbidities. Conclusion: MNT in the ICU is complex and requiring an interdisciplinary approach and frequent reevaluation. The impact of personalized and disease-specific MNT on patient-centered clinical outcomes remains to be elucidated.

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Section: Tailoring Mnt To the Individual Patient’s Needsmentioning

confidence: 99%

Nutrition in the Intensive Care Unit—A Narrative Review

Hill

Elke²,

Weimann

2021

Nutrients

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“…3 They also observed that the hypermetabolism persisted beyond 1 week post-ICU admission. 3 Others have suggested that the hypermetabolism may be sustained for 3 weeks post-ICU admission. 4 Disease conditions exhibiting hypermetabolism are generally associated with increased net protein catabolism.…”

Section: Discussionmentioning

confidence: 95%

“…Adjusted body weight was calculated in the ESPEN guidelines by: ideal body weight + ([actual weight -ideal body weight] × 0.25) 26 Recent indirect calorimetry studies demonstrate many critically ill patients with COVID-19 exhibit hypermetabolism. [3][4][5] One study indicated that hypermetabolism (measured energy expenditure > 110% of predicted) occurred in two-thirds of their patients. 3 They also observed that the hypermetabolism persisted beyond 1 week post-ICU admission.…”

Section: Discussionmentioning

confidence: 99%

“…20 At the time of writing this manuscript, we are aware of only two other published works (a preprint manuscript and a letter to the editor) whereby NBAL determinations were evaluated for patients with COVID-19. 3,27 Lakenman and associates 3 evaluated the nitrogen accretion response during the acute phase postadmission to the ICU (≤7 days) and during late phase (>7 days). Their data indicated net protein catabolism was not pronounced until the late phase.…”

Section: Discussionmentioning

confidence: 99%

“…1 Recent studies suggest critically ill patients with SARS-CoV-2 exhibit marked hypermetabolism which may be sustained for weeks. [3][4][5] Disease states with hypermetabolism are also often associated with increased net protein catabolism. 6,7 However, there is a paucity of data evaluating protein requirements for these patients.…”

Section: Introductionmentioning

confidence: 99%

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Protein requirements for critically ill ventilator‐dependent patients with COVID‐19

et al. 2021

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Background: Recent studies indicate critically ill patients with coronavirus disease 2019 (COVID-19) are hypermetabolic; however, protein requirements in critically ill COVID-19 patients are unknown. Our intent was to evaluate the nitrogen accretion response to varying protein intakes for critically ill ventilatordependent patients with COVID-19.Methods: Adult patients (age ≥ 18 years) with COVID-19, admitted to the intensive care unit (ICU) and who required mechanical ventilation were retrospectively evaluated. Patients received continuous enteral nutrition (EN), including supplemental protein boluses, and had a 24-h urine collection for determination of nitrogen balance (NBAL). Data are expressed as mean ± SD with a P-value < .05 as significant. Results: Twenty-two patients provided 29 NBAL determinations. Protein intake from EN and protein supplements was 0.9 ± 0.7 g/kg/day at the time of the NBAL with an NBAL of -12.1 ± 10.9 g/day at 7 ± 4 days in the ICU. Combined caloric intake from EN and propofol at the time of the NBAL was 12 ± 8 kcal/kg/day. Nitrogen equilibrium (NBAL of -4 g/day or better) occurred in five patients.Patients achieving nitrogen equilibrium received more protein than those with a negative NBAL (1.2 ± 0.4 g/kg/day vs 0.8 ± 0.8 g/kg/day, P = .046). The linear regression for NBAL in response to graded increases in protein intake was as follows: NBAL = 8.5 × protein intake (g/kg/day) -18.8 (r = 0.450, P < .001). Conclusion:Critically ill ventilator-dependent patients with COVID-19 exhibit significant variability in nitrogen accretion response to increases in protein intake and often have a markedly negative NBAL.

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Association between fat‐free mass and survival in critically ill patients with COVID‐19: A prospective cohort study

Lakenman,

van Marwijk,

van der Hoven

et al. 2023

J Parenter Enteral Nutr

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BackgroundMost critically ill patients with COVID‐19 experience malnutrition and weight loss associated with negative clinical outcomes. Our primary aim was to assess body composition during acute and late phase of illness in these patients in relation to clinical outcome and secondary to tailored nutrition support.MethodsThis prospective cohort study included adult critically ill patients with COVID‐19. Body composition (fat‐free mass [FFM] [exposure of interest], fat mass [FM], skeletal muscle mass [SMM], and phase angle [PA]) was determined with multifrequency bioelectrical impedance analyses in the acute and late phase. Nutrition support data were collected simultaneously. Clinical outcome was defined as ICU survival (primary outcome) and 30–90 days thereafter, duration of mechanical ventilation, and length ICU stay and of hospital stay (LOS). Nonparametric tests and regression analyses were performed.ResultsWe included 70 patients (73% male, median age 60 years). Upon admission, median BMI was 30 kg/m2, 54% were obese (BMI > 30 kg/m2). Median weight change during ICU stay was −3 kg: +3 kg FM and −6 kg FFM (−4 kg SMM). Body composition changed significantly (P < 0.001). Regarding clinical outcome, only low PA was associated with prolonged LOS (odds ratio = 0.83, 95% CI = 0.72–0.96; P = 0.015). Patients with optimal protein intake (>80%) during acute phase maintained significantly more FFM (2.7 kg, P = 0.047) in the late phase compared with patients who received <80%.ConclusionFFM decreased significantly during acute and late phase of illness, but we observed no association with ICU survival. Only low PA was associated with prolonged LOS. FFM wasting likely occurred because of disease severity and immobility.

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Energy expenditure and feeding practices and tolerance during the acute and late phase of critically ill COVID-19 patients

Cited by 32 publications

References 53 publications

Nutrition in the Intensive Care Unit—A Narrative Review

Nutrition in the Intensive Care Unit—A Narrative Review

Protein requirements for critically ill ventilator‐dependent patients with COVID‐19

Association between fat‐free mass and survival in critically ill patients with COVID‐19: A prospective cohort study

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