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

Abstract

Background: Patients who are critically ill with COVID-19 could have impaired nutrient absorption due to disruption of the normal intestinal mucosa. They are often in a state of high inflammation, increased stress and catabolism as well as a significant increase in energy and protein requirements. Therefore, timely enteral nutrition support and the provision of optimal nutrients are essential in preventing malnutrition in these patients. Aim: This review aims to evaluate the effects of enteral nutrition in critically ill patients with COVID-19. Method: This systematic review and meta-analysis was conducted based on the preferred reporting items for systematic review and meta-Analysis framework and PICO. Searches were conducted in databases, including EMBASE, Health Research databases and Google Scholar. Searches were conducted from database inception until 3 February 2022. The reference lists of articles were also searched for relevant articles. Results: Seven articles were included in the systematic review, and four articles were included in the meta-analysis. Two distinct areas were identified from the results of the systematic review and meta-analysis: the impact of enteral nutrition and gastrointestinal intolerance associated with enteral nutrition. The impact of enteral nutrition was further sub-divided into early enteral nutrition versus delayed enteral nutrition and enteral nutrition versus parenteral nutrition. The results of the meta-analysis of the effects of enteral nutrition in critically ill patients with COVID-19 showed that, overall, enteral nutrition was effective in significantly reducing the risk of mortality in these patients compared with the control with a risk ratio of 0.89 (95% CI, 0.79, 0.99, p = 0.04). Following sub-group analysis, the early enteral nutrition group also showed a significant reduction in the risk of mortality with a risk ratio of 0.89 (95% CI, 0.79, 1.00, p = 0.05). The Relative Risk Reduction (RRR) of mortality in patients with COVID-19 by early enteral nutrition was 11%. There was a significant reduction in the Sequential Organ Failure Assessment (SOFA) score in the early enteral nutrition group compared with the delayed enteral nutrition group. There was no significant difference between enteral nutrition and parenteral nutrition in relation to mortality (RR = 0.87; 95% CI, 0.59, 1.28, p = 0.48). Concerning the length of hospital stay, length of ICU stay and days on mechanical ventilation, while there were reductions in the number of days in the enteral nutrition group compared to the control (delayed enteral nutrition or parenteral nutrition), the differences were not significant (p > 0.05). Conclusion: The results showed that early enteral nutrition significantly (p < 0.05) reduced the risk of mortality among critically ill patients with COVID-19. However, early enteral nutrition or enteral nutrition did not significantly (p > 0.05) reduce the length of hospital stay, length of ICU stay and days on mechanical ventilation compared to delayed enteral nutrition or parenteral nutrition. More studies are needed to examine the effect of early enteral nutrition in patients with COVID-19.

A Snapshot of the Experience of Dietitians during the COVID-19 Crisis in Five Arab Countries: Findings from a Regional Cross-Sectional Study

“…To prevent malnutrition in these patients, immediate enteral nutrition support and the administration of adequate nutrients are crucial [31]. A recent systematic review and meta-analysis evidenced the effectiveness of enteral nutrition in alleviating the mortality risk among COVID-19 patients [31]. In the present study, the "Quick" method and the "Harris-Benedict equation" were the most used by dietitians to estimate the energy requirements of COVID-19 patients.…”

“…They frequently have considerable increases in their needs for protein and calories, as well as high levels of inflammation, stress, and catabolism [30]. To prevent malnutrition in these patients, immediate enteral nutrition support and the administration of adequate nutrients are crucial [31]. A recent systematic review and meta-analysis evidenced the effectiveness of enteral nutrition in alleviating the mortality risk among COVID-19 patients [31].…”

Body composition and risk factors associated with sarcopenia in post-COVID patients after moderate or severe COVID-19 infections

“…In COVID-19 hospitalized patients, malnutrition was 42.1%, which increased to 66.7% in patients admitted to the intensive care unit [ 59 ]. A meta-analysis performance by Ojo et al in critically ill patients with COVID-19 showed that early enteral nutrition reduced 11% the risk of mortality (RR: 89, 95%CI; 0.79 to 0.99) and a reduction in SOFA score [ 60 ].…”

Impact of COVID-19 on Short- and Medium-Term Prescription of Enteral Nutrition in the General Population vs. Older People in the Community of Madrid, Spain

“…Adequate nutritional treatment in patients with COVID-19 appears to be an important element and would be recommended as a method of primary nutritional support and in critically ill patients [ 26 , 27 ]. Different guidelines state the importance of nutrition risk screening in critically ill patients with COVID-19.…”