Energy target achievement and its determinants in critically ill COVID-19 patients in Indonesia

Abstract

Introduction. Achievement of energy target in critically ill Covid-19 patients in Intensive Care Unit (ICU) is challenging. This study was aimed to depict the possibility of achieving energy target and its determinants in critically ill Covid-19 patients.
 Methods. A cross sectional study was conducted in ICU of dr. Kariadi Hospital Semarang, Indonesia. Secondary data were obtained from Covid-19 patients who were in ICU for minimum 3 days, from March to December 2020. Data collected included age, sex, Body Mass Index (BMI), comorbidities, Modified Nutrition Risk in Critically Ill (mNUTRIC) score, energy intake, route of nutrition delivery (enteral or combination of enteral and parenteral nutrition), lactate status, ICU length of stay (LOS), duration of mechanical ventilator and mortality. Risk Prevalence calculations were conducted to measure risks. Variables with significant associations and p< 0.25 were included in multiple logistic regression.
 Results. A total of 188 subjects were included in the analysis. Most patients were male (62.8%) and obese (61.8%). As much as 56.9% patients were able to achieve energy target of 20 kcal/kgBW on day 3 of ICU stay. Those with low risk mNUTRIC score and nutrition delivery was through enteral and parenteral route were more likely to achieve target energy of 20 kcal/kgBW in the first 3 days in the ICU.
 Conclusions. Achieving energy target of 20 kcal on day 3 of ICU stay for critically ill Covid-19 patients is feasible. Low mNutric score and nutrition delivery through enteral and parenteral route were two determinants for the achievement.

Nutrition intake in critically ill patients with coronavirus disease (COVID-19): A nationwide, multicentre, observational study in Argentina

“…In an observational study performed on critically ill COVID-19 patients, 56.9% of the patients reached the caloric target of 20 kcal/kg on day three. 17 It is interesting to observe that the percentage of the adequacy of the requirements was low. According to current guidelines, many patients probably should have received supplemental parenteral nutrition but did not receive it.…”

“…This finding was also observed in another observational study conducted on COVID-19 patients, in which it was found that patients at high nutritional risk were more likely to achieve the caloric target of 20 kcal/kg/day within the first three days after ICU admission. 17 Moreover, in a retrospective observational study Zhang et al 24 recently demonstrated that a large proportion of ICU COVID-19 patients with a high nutritional risk revealed by their mNUTRIC score at ICU admission exhibited significantly higher mortality.…”

Inadequate energy and protein intake, underweight and malnutrition are associated with in‐hospital mortality among COVID‐19 rehabilitation patients during the omicron outbreak in Hong Kong

“…A study involving 52 intensive care unit (ICU) patients who had a protein intake of <0.8 g/kg body weight showed a higher mortality rate in these patients 31 . Another study of 112 critically ill patients with energy deficits in the first week of admission also resulted in a higher mortality rate 32 . Serum albumin has long been used to predict mortality and LOS 33 .…”

“…31 Another study of 112 critically ill patients with energy deficits in the first week of admission also resulted in a higher mortality rate. 32 Serum albumin has long been used to predict mortality and LOS. 33 Studies have suggested that COVID-19-induced cytokine causes critical hypoalbuminemia and that patients with lower serum albumin have poorer survival rates and longer LOS.…”