ABSTRACT
Introduction: Optimal calorie delivery is around 80% of predicted energy requirements.1 Underfeeding critical care patients may cause harm in some long stay patients.2 ESPEN guidelines state if oral intake is not possible, enteral nutrition should commence within 48 hours. Calorie delivery can be increased to 80-100% after day three of admission to ICU.3 The Nightingale ICU was situated on an acute ward which was modified to function as an ICU. This was to facilitate increased admissions of COVID-19. The Nightingale dietetic team were redeployed from acute and community settings in from within the trust, with various levels of ICU experience. The team provided seven day dietetic cover based on a rota, including bank holidays. Objectives: The aim of this audit was to evaluate enteral feed delivery and the number of days taken to reach target rate of feed compared to the regimen set by the dietitian, in patients with COVID-19 admitted to Nightingale ICU. Methods: At each review, dietitians calculated enteral feed delivery over the preceding 24 hours as a percentage of the target regimen, from the input recorded on the fluid balance chart. The number of days to reach enteral feed delivery targets were calculated relative to dietetic plans. All patients who required enteral nutrition from 15/10/ 2020 until 11/03/2021 were eligible for inclusion. Days where enteral feed was not required, target rate of enteral feed was not yet due to be achieved, parenteral nutrition was required, or following ICU discharge and end of life care were excluded. Days where enteral nutrition delivery information was unavailable were also excluded from the analysis. No imputation was used to estimate missing data. Results: The data consisted of a total of 116 patients. Following exclusions, the total number of patients included in the analysis was 107. Mean age was 63.6 ± 9.4 years.Mean body mass index (BMI) was 32.7 ± 7.4kg/m2. Number of enteral feed days per patient was 11. Patients with COVID-19 admitted to Nightingale ICU received a median of 84% of their enteral feeding regimen. The feeding regimen set by the dietitian aimed to achieve target rate of feed by 3.1 days. The data analysis showed the mean number of days until the target was achieved was 3.5 days. Conclusion: Results are based on a homogenous COVID-19 ICU cohort. Dietetic staffing levels were increased, and seven-day working was provided in response to the COVID-19 pandemic compared to a standard ICU. Quantifying common reasons for feed interruptions could be explored further. Despite suboptimal COVID-19 Nightingale ICU conditions, enteral feed delivery and time taken to reach target rate of feed was in keeping with ESPEN guidelines.