ABSTRACT
Coronavirus disease 2019 (COVID-19) has rapidly spread across the globe. Large numbers of patients with severe acute respiratory syndrome associated with COVID-19 have required Intensive Care (ICU) input to manage their condition.1 Requirements such as proning patients may impact on the ability to successfully deliver nutritional support. To date, little data has been published on the nutritional management of these patients whilst on ICU. We previously reported a retrospective analysis of the management and 28-day outcomes of 316 consecutive adult patients with SARS-CoV-2 PCR-confirmed COVID-19 admitted to our centre, within the first wave of the pandemic between 8th January 2020 and 16th April 2020.2 The study was registered as a clinical service evaluation and was exempt from ethical approval. A total of 316 patients (55% male) were identified with a median (IQR) [range] age of 75 (60 – 83) [23 – 101] years. Fifty-nine (19%) patients were admitted to ICU, median age 60. In total, 84 (27%) patients died within 28 days of admission (or before discharge where admission duration >28 days). Of those patients admitted to IC4 (24%) died. We here present further hitherto unpublished analyses of the nutritional status, intervention and outcomes of those patients admitted to ICU. Thirty-one (52%) of patients required intubation during their ICU stay, 6 (10%) required tracheostomy and 16 (27%) required proning during their stay. When required, proning lasted on average 2.7 days. Median length of stay on ICU was 8.5 days (range 1-51). Mean admission weight for those patients admitted to ICU was 102kg and was recorded in 26 (44%) of those admitted to ICU. This compared to the wider hospital admission cohort, where weight was recorded in 151/316 (48%) patients, with a median [range] 74.5kg [32.4-168]. Where measured (20 [34%]), there was significant weight loss observed during admission in those patients whose stay included ICU;mean (SD) weight 100kg (22.2) at admission and 91.1kg (21.4)) last recorded weight during admission (P=0.04). Thirty-five (59%) of patients who were admitted to ICU received dietetic input, compared to 48 (19%) patients admitted elsewhere in the hospital. Thirty-four (58%) of patients admitted to ICU required enteral feeding, all occurring via nasogastric tube. Fifty-three (17%) of patients received oral nutritional supplements whilst an inpatient and 38 (12%) received enteral feeding. Of those patients receiving enteral feeding on ICU, 33 (97%) had tube placement confirmed by chest x-ray. Information on feed regime was available on 30 patients on ICU. Mean (SD) prescribed feed calories was 1507 kcal/24 hours (255), compared to mean (SD) feed delivered 1321 kcal/24 hours (372) (P=0.0001). Mean (SD) prescribed protein was 86g/24 hours (20) versus mean protein delivered was 67g/24 hours (P=0.0001). Median duration of enteral feeding on ICU was 12.5 days (range 2-52). Results indicate that enteral feeding on ICU can be successfully delivered in patients with COVID-19. Updated advice on enteral tube feeding safety including confirmation of tube placement was followed in the majority of cases.2 Future studies should aim to establish greater depth of understanding on the impact of different enteral feeding regimes on COVID-19 outcome. 4. Armstrong, R.A., Kane, A.D., Cook, T.M. Anaesthesia. 2020 Oct;75(10):1340-1349 Outcomes from intensive care in patients with COVID-19: a systematic review and meta-analysis of observational studies 5. Baker KF, Hanrath AT, Schim van der Loeff I, Tee SA, Capstick R, Marchitelli G, Li A, Barr A, Eid A, Ahmed S, Bajwa D, Mohammed O, Alderson N, Lendrem C, Lendrem DW, COVID-19 Control Group, COVID-19 Clinical Group, Pareja-Cebrian L, Welch A, Field J, Payne BAI, Taha Y, Price DA, Gibbins C, Schmid ML, Hunter E, Duncan CJA. COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis. Med Sci (2021);9(1):6. 6. Nasogastric tube safety Special Interest Group. May 2020. Enteral tube feeding safety in COVID-19 pat ents. BAPEN. )
ABSTRACT
Coronavirus disease 2019 (COVID-19) has rapidly spread across the globe. Elderly individuals and patients with comorbidities such as obesity, diabetes, and hypertension have been shown to have a higher risk of hospitalization, severe disease, and mortality.1 To date, little data has been published on the timely identification and correction of undernutrition in patients hospitalised with COVID-19. We previously reported a retrospective analysis of the management and 28-day outcomes of 316 consecutive adult patients with SARS-CoV-2 PCR-confirmed COVID-19 admitted to our centre, within the first wave of the pandemic between 8th January 2020 and 16th April 2020.2 The study was registered as a clinical service evaluation and was exempt from ethical approval. A total of 316 patients (55% male) were identified with a median (IQR) [range] age of 75 (60 – 83) [23 – 101] years. Twenty-seven of 316 (9%) patients were healthcare workers, and 60 (19%) were admitted from a care home. The median (IQR) duration of admission was 8 (4 – 14) days, and 59 (19%) patients were admitted to critical care. In total, 84 (27%) patients died within 28 days of admission (or before discharge where admission duration >28 days). We here present further hitherto unpublished analyses of the nutritional status, intervention and outcomes of this cohort. Gastrointestinal symptoms present at admission were: anorexia (97 [31%]), diarrhoea (64 [20%]), vomiting (43 [14%]) and abdominal pain (33 [10%]). Admission weight was recorded in 151 (48%) patients, with a median [range] 74.5kg [32.4-168.0]. Where measured (62 [20%] patients), there was significant weight loss observed during admission;median (IQR) weight 77.4kg (65.5-96) at admission and 73.7kg (61.4-94.5) last recorded weight on admission (P=0.0001, paired Wilcoxon signed-rank test). Forty-eight (15%) patients were assessed by a dietitian during their admission. Fifty-three (17%) patients received oral nutritional supplements whilst an inpatient and 38 (12%) received enteral feeding. Of those patients receiving enteral feeding, 30 (79%) had tube placement confirmed by chest x-ray. In conclusion, gastrointestinal symptoms that are commonly associated with reduced nutritional intake were common in these patients hospitalised with COVID-19. There was evidence of reduced nutritional screening on admission compared with pre-COVID practice. This may have been associated with barriers associated with initial infection prevention and control requirements as well as focus on respiratory issues, and should be addressed in future waves of infection. Updated safety advice on enteral tube feeding including confirmation of tube placement was followed in the majority of cases.3 Future studies should aim to better establish the particular circumstances in COVID-19 where nutritional support impacts outcome. 1. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention 2020 Apr 7;323(13):1239-1242. 2. Baker KF, Hanrath AT, Schim van der Loeff I, Tee SA, Capstick R, Marchitelli G, Li A, Barr A, Eid A, Ahmed S, Bajwa D, Mohammed O, Alderson N, Lendrem C, Lendrem DW, COVID-19 Control Group, COVID-19 Clinical Group, Pareja-Cebrian L, Welch A, Field J, Payne BAI, Taha Y, Price DA, Gibbins C, Schmid ML, Hunter E, Duncan CJA. COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis. Med Sci (2021);9(1):6. 3. Nasogastric tube safety Special Interest Group. May 2020. Enteral tube feeding safety in COVID-19 patients. BAPEN. )