Specific nutrition and metabolic characteristics of critically ill patients with persistent COVID‐19

Abstract

Background Little is known about metabolic and nutrition characteristics of patients with coronavirus disease 2019 (COVID‐19) and persistent critical illness. We aimed to compare those characteristics in patients with PCI and COVID‐19 and patients without COVID‐19 infection (non‐CO)—primarily, their energy balance. Methods This is a prospective observational study including two consecutive cohorts, defined as needing intubation for >10 days. We collected demographic data, severity scores, nutrition variables, length of stay, and mortality. Results Altogether, 104 patients (52 per group) were included (59 ± 14 years old [mean ± SD], 75% men) between July 2019 and May 2020. SAPSII, Nutrition Risk Screening (NRS) score, proportion of obese patients, duration of intubation (18.2 ± 11.7 days), and mortality rates were similar. Patients with COVID‐19 (vs non‐CO) had lower SOFA scores ( P = 0.013) and more frequently needed prone position ( P < 0.0001) and neuromuscular blockade ( P < 0.0001): lengths of ICU ( P = 0.03) and hospital stays were shorter ( P < 0.0001). Prescribed energy targets were below those of the ICU protocol. The energy balance of patients with COVID‐19 was significantly more negative after day 10. Enteral nutrition (EN) started earlier ( P < 0.0001). During the first 10 days, COVID‐19 patients received more lipid (propofol sedation) and less protein. Higher admission C‐reactive protein ( P = 0.002) decreased faster ( P < 0.001). Whereas intestinal function was characterized by constipation in both groups during the first 10 days, diarrhea was less common in patients with COVID‐19 thereafter. Conclusion Compared with non‐CO patients, COVID‐19 patients were not more obese, had lower SOFA scores, and were fed more rapidly with EN, because of a more normal gastrointestinal function possibly due to fewer non–respiratory organ failures: their energy balances were more negative after the first 10 days. Propofol sedation reduced protein delivery.

α1-Adrenergic Receptors: Insights into Potential Therapeutic Opportunities for COVID-19, Heart Failure, and Alzheimer’s Disease

“…PKG1 binding and activation has also been demonstrated in related α 1 -AR antagonists that contain quinazoline motifs, such as alfuzosin, prazosin, and doxazosin [ 140 ]. PGK1 activation may improve cellular functions in disorders with an established energy deficit, common with critically ill patients [ 141 ] and COVID-19 patients [ 142 , 143 ]. Terazosin was shown to increase PGK1 activity and glycolysis in motor neuron models of amyotrophic lateral sclerosis (ALS), which correlated with protection and survival [ 144 ].…”

Enteral feeding tolerance during pharmacologic neuromuscular blockade

“…Tube feedings were resumed in 73% of patients with an undetectable concentration compared with 89% of those with detectable serum concentrations. Viana et al 42 : Data regarding metabolism and nutritionrelated variables were prospectively collected in 52 critically ill patients with COVID-19 and 52 ventilator-dependent patients without COVID-19 to identify specific problems related to their management. Ninety-eight percent of patients with COVID-19 received NMB compared with 75% of those without COVID-19.…”

Clinical nutrition issues in 2022: What is missing to trust supplemental parenteral nutrition (SPN) in ICU patients?

“…The NUTRIC score appears to be a predictor of overall mortality and indicates potential interactions between nutritional interventions, disease states, and outcomes [ 2 ][ 2 ]. The NRS score requires further prospective validation [ 2 , 12 ]. This absence of good scoring option probably reflects the organism’s response to stress with an early EGP, which covers up to 60% of energy needs [ 4 , 13 ].…”