Safety and tolerance of enteral nutrition in COVID-19 critically ill patients, a retrospective study

Abstract

Background There is a lack of evidence about the tolerance of enteral nutrition (EN) in COVID-19 critically ill patients. However, several gastrointestinal manifestations related to COVID-19 have been described. The aims of this study were to analyze the incidence of gastrointestinal intolerance (GI) associated to EN (diarrhea, vomiting, gastroparesis and constipation) and to describe energy/protein provision along with biochemical alterations during the first week of EN. Methods A retrospective cohort of COVID-19 critically ill patients under mechanical ventilation. We reported daily enteral nutrition infusion and gastrointestinal manifestations within the first week of intubation and enteral nutrition initiation. Results Fifty-two patients were included; 40.3% were overweight and 46.2% were obese. During the first 7 days of EN, manifestations of GI intolerance such as vomiting, diarrhea and gastroparesis were present in 18 patients (32.4%). Hypernatremia (39%) was the most frequent electrolyte abnormality. Only Acute Kidney Injury (AKI) diagnosis was associated with a higher energy deficit on day 7. No associations between drug prescription and GI intolerance were observed. On day 4, 94.5% of patients were receiving more than 80% of energy requirements and 94.2% of protein requirements. Accumulated energy and protein deficits at day 3 were 2171.2 ± 945 kcal and 114.9 ± 49.2 g, respectively; and 2586.4 ± 1151 kcal, 133.3 ± 60.4 g at day 7. Conclusion Enteral nutrition is feasible and well-tolerated in COVID-19 patients with mechanical ventilation within the first week of enteral nutrition initiation. More studies are needed to elucidate the impact of nutritional therapy on infection course and outcomes.

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

“…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.…”

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

“…A retrospective cohort study in critically ill Covid-19 patients reported that early enteral nutrition was feasible and safe for this group of patients during the first week of ICU stays. 22 Another retrospective study in critically ill Covid-19 patients receiving mechanical ventilator revealed that administration of EN in the first 24 hour of mechanical ventilation did no harm to the patients. 23 Our study also found that combining EN with PN made achievement of energy target of day 3 in ICU is possible.…”

“…The previous retrospective study in critically ill Covid-19 patients on mechanical ventilator also found that main reason for interruptions of enteral nutrition during the first week were hemodynamic instability and GI intolerance. 22 When an enteral route was used without any supplemental PN, it seemed that disruption of enteral feeding due to gastrointestinal intolerance/bleeding, unstable hemodynamic and fasting related procedure led to failure of energy target achievement at day 3. Adding supplemental parenteral nutrition seems feasible and safe for our subjects.…”

The Effects of Enteral Nutrition in Critically Ill Patients with COVID-19: A Systematic Review and Meta-Analysis

“…Over 93 million patients have been affected by coronavirus (COVID-19) caused by SARS-CoV-2 as of January 2021 [ 7 ]. Furthermore, there is evidence that about 30% of those hospitalised are admitted to ICU for ventilatory support [ 7 ].…”

“…Over 93 million patients have been affected by coronavirus (COVID-19) caused by SARS-CoV-2 as of January 2021 [ 7 ]. Furthermore, there is evidence that about 30% of those hospitalised are admitted to ICU for ventilatory support [ 7 ]. According to the National Nurses Nutrition Group (NNNG) [ 8 ], wherever possible, oral nutrition support should be considered as first line nutritional intervention.…”