Feeding intolerance in critically ill patients with COVID-19

Liu, Rebecca; Paz, Mary; Siraj, Layla; Boyd, Taylor; Salamone, Silvia; Lite, Thúy Lan Võ; Leung, Krystle M.; Chirinos, Josue D; Shang, Helen H.; Townsend, Matthew J.; Rho, Junsung; Ni, Peiyun; Ranganath, Kushi; Violante, April D.; Zhao, Zezhou; Silvernale, Casey J.; Ahmad, Imama; Krasnow, Nira A.; Barnett, Erica S.; Harisinghani, Mukesh G.; Kuo, Braden; Black, Katharine E.; Staller, Kyle

doi:10.1016/j.clnu.2021.03.033

Cited by 29 publications

(35 citation statements)

References 39 publications

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“…In fact, the amount of proteins administered with the nutritional support was significantly lower in non-survivors (see figure 2 ). One possible explanation for such a reduced protein administration might be a higher incidence of intolerance to enteral feeding in non-survivors, which is known to be a marker of a more severe disease state and associated with a worse outcome, especially in the COVID-19 population [62] . No differences were found in the cumulative energy (calorie) deficit, likely because a significant part of the calorie provision came from intravenous lipids from propofol infusion.…”

Section: Discussionmentioning

confidence: 99%

Qualitative and quantitative muscle ultrasound changes in patients with COVID-19–related ARDS

et al. 2021

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Background & Aims Severe forms of COVID-19 are associated with systemic inflammation and hypercatabolism. We compared the time course of the size and quality of both rectus femoris and diaphragm muscles between critically-ill, COVID-19 survivors and non-survivors, and explored the correlation between the change in muscles size and quality with the amount of nutritional support delivered and the cumulative fluid balance. Methods Prospective observational study in the general ICU of a tertiary care hospital for COVID-19. The right rectus femoris cross-sectional area and the right diaphragm thickness, as well as their echodensities were assessed within 24 hours from ICU admission and on day 7. Anthropometric and biochemical data, respiratory mechanics and gas exchange, daily fluid balance and the amount of calories and proteins administered were recorded. Results 28 patients were analysed (age 65±10 years, 80% males, BMI 30.0±7.8). Rectus femoris and diaphragm sizes were significantly reduced at day 7 (-26.1 [-37.8;-15.2] and -29.2 [-37.8;-19.6]%, respectively) and this reduction was significantly higher in non-survivors. Both rectus femoris and diaphragm echodensity were significantly increased at day 7, with a significantly higher increase in non-survivors. The change in both rectus femoris and diaphragm size at day 7 was related to the cumulative protein deficit (R=0.664, p<0.001 and R=0.640, p<0.001, respectively), while the change in rectus femoris and diaphragm echodensity was related to the cumulative fluid balance (R=0.734, p<0.001 and R=0.646, p<0.001, respectively) Conclusions Early changes in muscle size and quality seem related to the outcome of critically-ill, COVID-19 patients, and be influenced by nutritional and fluid management strategies.

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Section: Discussionmentioning

confidence: 99%

Qualitative and quantitative muscle ultrasound changes in patients with COVID-19–related ARDS

et al. 2021

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“…Several factors could explain malnutrition during this acute phase, including marked systemic inflammation driving hypermetabolism and muscle catabolism, and prolonged periods of bedrest driving disuse atrophy. Up to 40% of patients with COVID-19 experience gastrointestinal symptoms ranging from nausea, vomiting, anorexia, diarrhea and abdominal distention, especially in ICU COVID patients [4], which can further deter eating and impact the tolerance of nutritional support [5]. Olfactory and gustatory dysfunction [6] may also contribute to weight loss [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…Medical teams have become increasingly aware of the importance of multidisciplinary care, taking into account fatigue and functional disability, but nevertheless overlooking the nutritional aspect and the importance of the decrease in muscle strength [1]. Nowadays, muscle weakness and fatigue appear as a frequent complaint among these patients [4,5].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Evolution of Malnutrition and Loss of Muscle Strength after COVID-19: A Major and Neglected Component of Long COVID-19

et al. 2021

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Post-acute consequences of COVID-19, also termed long COVID, include signs and symptoms persisting for more than 12 weeks with prolonged multisystem involvement; most often, however, malnutrition is ignored. Method: The objective was to analyze persistent symptoms, nutritional status, the evolution of muscle strength and performance status (PS) at 6 months post-discharge in a cohort of COVID-19 survivors. Results: Of 549 consecutive patients hospitalized for COVID-19 between 1 March and 29 April 2020, 23.7% died and 288 patients were at home at D30 post-discharge. At this date, 136 of them (47.2%) presented persistent malnutrition, a significant decrease in muscle strength or a PS ≥ 2. These patients received dietary counseling, nutritional supplementation, adapted physical activity guidance or physiotherapy assistance, or were admitted to post-care facilities. At 6 months post-discharge, 91.0% of the 136 patients (n = 119) were evaluated and 36.0% had persistent malnutrition, 14.3% complained of a significant decrease in muscle strength and 14.9% had a performance status > 2. Obesity was more frequent in patients with impairment than in those without (52.8% vs. 31.0%; p = 0.0071), with these patients being admitted more frequently to ICUs (50.9% vs. 31.3%; p = 0.010). Among those with persistent symptoms, 10% had psychiatric co-morbidities (mood disorders, anxiety, or post-traumatic stress syndrome), 7.6% had prolonged pneumological symptoms and 4.2% had neurological symptoms. Conclusions: Obese subjects as well as patients who have stayed in intensive care have a higher risk of functional loss or undernutrition 6 months after a severe COVID infection. Malnutrition and loss of muscle strength should be considered in the clinical assessment of these patients.

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“…Only a few studies so far have provided limited data about nutrition support. A USA cohort [ 24 ] revealed that more than half of the participants (56%) presented intolerance to enteral nutrition, which was associated with higher ICU stay and in-hospital mortality, whereas a similar study among intubated patients from Mexico revealed a lower prevalence of intolerance to enteral nutrition—about 32% [ 25 ]. A series of 176 critically ill patients with COVID-19 disease [ 26 ] managed to reach their energy and protein requirements during the first week of admission especially through the use of supplemental parenteral nutrition.…”

Section: Discussionmentioning

confidence: 99%

Does Route of Full Feeding Affect Outcome among Ventilated Critically Ill COVID-19 Patients: A Prospective Observational Study

et al. 2021

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The outbreak of the new coronavirus strain SARS-CoV-2 (COVID-19) highlighted the need for appropriate feeding practices among critically ill patients admitted to the intensive care unit (ICU). This study aimed to describe feeding practices of intubated COVID-19 patients during their second week of hospitalization in the First Department of Critical Care Medicine, Evaggelismos General Hospital, and evaluate potential associations with all cause 30-day mortality, length of hospital stay, and duration of mechanical ventilation. We enrolled adult intubated COVID-19 patients admitted to the ICU between September 2020 and July 2021 and prospectively monitored until their hospital discharge. Of the 162 patients analyzed (52.8% men, 51.6% overweight/obese, mean age 63.2 ± 11.9 years), 27.2% of patients used parenteral nutrition, while the rest were fed enterally. By 30 days, 34.2% of the patients in the parenteral group had died compared to 32.7% of the patients in the enteral group (relative risk (RR) for the group receiving enteral nutrition = 0.97, 95% confidence interval = 0.88–1.06, p = 0.120). Those in the enteral group demonstrated a lower duration of hospital stay (RR = 0.91, 95% CI = 0.85-0.97, p = 0.036) as well as mechanical ventilation support (RR = 0.94, 95% CI = 0.89–0.99, p = 0.043). Enteral feeding during second week of ICU hospitalization may be associated with a shorter duration of hospitalization and stay in mechanical ventilation support among critically ill intubated patients with COVID-19.

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Feeding intolerance in critically ill patients with COVID-19

Cited by 29 publications

References 39 publications

Qualitative and quantitative muscle ultrasound changes in patients with COVID-19–related ARDS

Qualitative and quantitative muscle ultrasound changes in patients with COVID-19–related ARDS

Long-Term Evolution of Malnutrition and Loss of Muscle Strength after COVID-19: A Major and Neglected Component of Long COVID-19

Does Route of Full Feeding Affect Outcome among Ventilated Critically Ill COVID-19 Patients: A Prospective Observational Study

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