Analysis of nutrition support in COVID19 critical care patients

The aim of this analysis was to determine route and adequacy of nutrition support in patients with COVID19 during the first 7 days of admission to an intensive care unit (ICU). Nutrition parameters were collected for all patients admitted to ICU with COVID19 and compared to best practice guidelines1. Of the initial 64 patients admitted to ICU for management of COVID19, all patients were assessed by a critical care dietitian. Patients who were tolerating oral diet were commenced on oral nutrition support as appropriate. Forty eight patients (75%) required enteral nutrition (EN) or parenteral nutrition (PN). The feeding route of choice for the majority of patients was EN (89.5%). In patients with gastrointestinal (GI) intolerance where strategies to optimise tolerance were unsuccessful, supplementary or total PN was used (10.5%). Energy and protein intakes during the early and late acute phase are described below. [Formula presented] Energy intakes in the early acute phase were consistent with best practice guidelines while protein provision was a challenge in both phases. GI intolerance was common which compromised nutrition intakes, though proned position did not affect these outcomes. Where strategies to improve GI tolerance are unsuccessful supplementary PN should be considered without delay to optimise nutrition intake. References: 1Singer et al. Clinical Nutrition (2019) 38(1), 48-79. Disclosure of Interest: None Declared

Analysis of nutrition support in Covid19 critical care patients

Rationale: The aim of this analysis was to determine route and adequacy of nutrition support in patients with COVID19 during the first 7 days of admission to an intensive care unit (ICU). Methods: Nutrition parameters were collected for all patients admitted to ICU with COVID19 and compared to best practice guidelines1. Results: Of the initial 64 patients admitted to ICU for management of COVID19, all patients were assessed by a critical care dietitian. Patients who were tolerating oral diet were commenced on oral nutrition support as appropriate. Forty eight patients (75%) required enteral nutrition (EN) or parenteral nutrition (PN). The feeding route of choice for the majority of patients was EN (89.5%). In patients with gastrointestinal (GI) intolerance where strategies to optimise tolerance were unsuccessful, supplementary or total PN was used (10.5%). Energy and protein intakes during the early and late acute phase are described below. [Formula presented] The most common reason for suboptimal nutrition intake in the late acute phase was GI intolerance, affecting 27% of patients. Compared with those without GI intolerance, patients who experienced feed regurgitation, vomiting or high gastric residual volumes achieved significantly less energy and protein intakes (p≤0.05). Proned position did not affect GI tolerance in our cohort (p=0.65). Conclusion: Energy intakes in the early acute phase were consistent with best practice guidelines while protein provision was a challenge in both phases. GI intolerance was common which compromised nutrition intakes, though proned position did not affect these outcomes. Where strategies to improve GI tolerance are unsuccessful supplementary PN should be considered without delay to optimise nutrition intake. References: 1Singer et al. Clinical Nutrition (2019) 38(1), 48-79. Disclosure of Interest: None declared.

Weight status of patients admitted to an Intensive Care Unit for management of COVID19

Rationale: Obesity has been proposed as a risk factor for severe illness and invasive ventilation in patients with COVID191. Additionally, malnutrition is highly prevalent in critically unwell patients, regardless of baseline weight status2. The aim of this analysis was to determine the baseline weight status and weight change in patients admitted to an intensive care unit (ICU) for management of COVID19. Methods: Baseline weight on admission to ICU was collected from the records of all patients admitted with COVID19. Weight change during ICU admission was calculated for patients who survived and had an ICU length of stay (LOS) ≥ 5 days. Results: Sixty four patients were admitted to the ICU for management of COVID19 (mean age 60.6yrs (range 21-90yrs), 66% male, mean ICU LOS 16.5 days (range 1-71days)). Weight status in this cohort is presented below. [Formula presented] 69% of patients experienced at least 5% weight loss during ICU admission and 31% had greater than 10% weight loss, despite provision of nutrition support. Conclusion: Overweight and obesity were prevalent in patients admitted to our ICU for management of COVID19. Significant weight loss in this cohort confirms that malnutrition and obesity co-exist in critically unwell patients. These findings are consistent with emerging data from other centres internationally3 and inform appropriate nutritional management of this cohort of critically ill patients. References: 1Simonnet et al. Obesity (2020) 28: 1195-1199, 2Lew et al. JPEN (2017) 41(5):744–58, 3House et al., ICNARC 2020. Disclosure of Interest: None declared.