ABSTRACT
Background and aims To investigate the incidence and the severity of COVID-19 infection in patients enrolled in the database for home parenteral nutrition (HPN) for chronic intestinal failure (CIF) of the European Society for Clinical Nutrition and Metabolism (ESPEN). Methods Period of observation: March 1st, 2020 March 1st, 2021. Inclusion criteria: patients included in the database since 2015 and still receiving HPN on March 1st, 2020 as well as new patients included in the database during the period of observation. Data related to the previous 12 months and recorded on March 1st 2021: 1) occurrence of COVID-19 infection since the beginning of the pandemic (yes, no, unknown);2) infection severity (asymptomatic;mild, no-hospitalization;moderate, hospitalization no-ICU;severe, hospitalization in ICU);3) vaccinated against COVID-19 (yes, no, unknown);4) patient outcome on March 1st 2021: still on HPN, weaned off HPN, deceased, lost to follow up. Results Sixty-eight centres from 23 countries included 4,680 patients. Data on COVID-19 were available for 55.1% of patients. The cumulative incidence of infection was 9.6% in the total group and ranged from 0% to 21.9% in the cohorts of individual countries. Infection severity was reported as: asymptomatic 26.7%, mild 32.0%, moderate 36.0%, severe 5.3%. Vaccination status was unknown in 62.0% of patients, non-vaccinated 25.2%, vaccinated 12.8%. Patient outcome was reported as: still on HPN 78.6%, weaned off HPN 10.6%, deceased 9.7%, lost to follow up 1.1%. A higher incidence of infection (p=0.04), greater severity of infection (p<0.001) and a lower vaccination percentage (p=0.01) were observed in deceased patients. In COVID-19 infected patients, deaths due to infection accounted for 42.8% of total deaths. Conclusions In patients on HPN for CIF, the incidence of COVID-19 infection differed greatly among countries. Although the majority of cases were reported to be asymptomatic or have mild symptoms only, COVID-19 was reported to be fatal in a significant proportion of infected patients. Lack of vaccination was associated with a higher risk of death.
ABSTRACT
In around 10% of SARS-CoV-2 infected patients, coronavirus disease-2019 (Covid-19) symptoms are complicated with a severe lung damage called Acute Respiratory Distress Syndrome (ARDS), which is often lethal. ARDS is mainly associated with an uncontrolled overproduction of immune cells and cytokines, called "cytokine storm syndrome"; it appears 7-15 days following the onset of symptoms, leading to systemic inflammation and multiple organ failure. Because they are well-known metabolic precursors of specialized pro-resolving lipid mediators (SPMs), omega-3 long-chain polyunsaturated fatty acids (omega-3 LC-PUFAs) could help improve the resolution of the inflammatory balance, limiting therefore the level and duration of the critical inflammatory period. Omega-3 LC-PUFAs may also interact at different stages of the viral infection, notably on the virus entry and replication. In the absence of demonstrated treatment and while waiting for vaccine possibility, the use of omega-3 LC-PUFAs deserve therefore to be considered, based on previous clinical studies suggesting that omega-3 supplementation could improve clinical outcomes of critically ill patients at the acute phase of ARDS. In this context, it is crucial to remind that the omega-3 PUFA dietary intake levels in Western countries remains largely below the current recommendations, considering both the omega-3 precursor α-linolenic acid (ALA) and long chain derivatives such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). An optimized omega-3 PUFAs status could be helpful to prevent infectious diseases, including Covid-19.
Subject(s)
COVID-19/complications , Dietary Supplements , Fatty Acids, Omega-3/pharmacology , Animals , Clinical Trials as Topic , HumansABSTRACT
The viral epidemic caused by the new Coronavirus SARS-CoV-2 is responsible for the new Coronavirus disease-2019 (Covid-19). This epidemic imposes upheavals in our organizations in healthcare centres, which should not obscure the importance of nutritional care. The nutritional diagnosis and the early nutritional care management of Covid-19 patients must be integrated into the overall therapeutic strategy, as with any acute situation of acute illness. This document was prepared by the French speaking Society for Clinical Nutrition and Metabolism (SFNCM) in the emergency of the health crisis by a group of experts, based on the national and international recommendations available in the field of malnutrition, critical illness, metabolic stress and intensive care medicine on March 23, 2020. We hope that this article will bring to healthcare professionals especially those not specialized in nutrition, useful landmarks to help them to manage hospitalized patients, infected or not by Covid-19 in the context of epidemic and intrahospital confinement.
ABSTRACT
The viral epidemic caused by the new Coronavirus SARS-CoV-2 is responsible for the new Coronavirus disease-2019 (Covid-19). Fifteen percent of the Covid-19 patients will require hospital stay, and 10% of them will need urgent respiratory and hemodynamic support in the intensive care unit (ICU). Covid-19 is an infectious disease characterized by inflammatory syndrome, itself leading to reduced food intake and increased muscle catabolism. Therefore Covid-19 patients are at high risk of being malnourished, making the prevention of malnutrition and the nutritional management key aspects of care. Urgent, brutal and massive arrivals of patients needing urgent respiratory care and artificial ventilation lead to the necessity to reorganize hospital care, wards and staff. In that context, nutritional screening and care may not be considered a priority. Moreover, at the start of the epidemic, due to mask and other protecting material shortage, the risk of healthcare givers contamination have led to not using enteral nutrition, although indicated, because nasogastric tube insertion is an aerosol-generating procedure. Clinical nutrition practice based on the international guidelines should therefore adapt and the use of degraded procedures could unfortunately be the only way. Based on the experience from the first weeks of the epidemic in France, we emphasize ten challenges for clinical nutrition practice. The objective is to bring objective answers to the most frequently met issues to help the clinical nutrition caregivers to promote nutritional care in the hospitalized Covid-19 patient. We propose a flow chart for optimizing the nutrition management of the Covid-19 patients in the non-ICU wards.
Subject(s)
COVID-19/complications , Critical Care/trends , Malnutrition/therapy , Nutritional Support/trends , France/epidemiology , Humans , Malnutrition/diagnosis , Malnutrition/virology , Nutrition Assessment , SARS-CoV-2ABSTRACT
Five to 10% of the coronavirus SARS-CoV-2-infected patients, i.e., with new coronavirus disease 2019 (COVID-19), are presenting with an acute respiratory distress syndrome (ARDS) requiring urgent respiratory and hemodynamic support in the intensive care unit (ICU). However, nutrition is an important element of care. The nutritional assessment and the early nutritional care management of COVID-19 patients must be integrated into the overall therapeutic strategy. The international recommendations on nutrition in the ICU should be followed. Some specific issues about the nutrition of the COVID-19 patients in the ICU should be emphasized. We propose a flow chart and ten key issues for optimizing the nutrition management of COVID-19 patients in the ICU.
Subject(s)
Coronavirus Infections/therapy , Intensive Care Units , Nutrition Therapy , Pneumonia, Viral/therapy , COVID-19 , Humans , Nutrition Assessment , Pandemics , Practice Guidelines as Topic , Randomized Controlled Trials as TopicABSTRACT
Résumé La nutrition artificielle à domicile, entérale ou parentérale, s’adresse à des malades chroniques fragiles. La situation actuelle de pandémie COVID-19 peut compromettre leur prise en charge à plusieurs niveaux : difficultés d’accès aux établissements de santé largement réorientés vers la prise en charge des malades COVID-19, possible pénurie d’infirmières à domicile, forte réduction des visites des prestataires de service à domicile, tensions sur les solutions hydro-alcooliques, les masques et les régulateurs de débit. Le but de ces recommandations établies par le Comité de Nutrition à Domicile de la Société Francophone de Nutrition Clinique et Métabolisme est, d’une part, de préciser la prise en charge minimale de ces patients, tant en termes de suivi que de matériels, mais surtout de s’adapter aux tensions actuelles relatives aux personnes et aux matériels, afin de poursuivre une prise en charge de qualité et de ne pas compromettre l’état de santé des patients en nutrition artificielle à domicile pendant la crise. Home artificial nutrition, whether enteral or parenteral, is provided to chronic and fragile patients. The current COVID-19 epidemics may compromise their care at several levels: difficulties to access to hospitals mainly focused on treating COVID-19 patients, possible lack of nurses at home, strong reduction of visits by homecare providers, tended flow or lack of hand sanitizers, surgical masks and pumps. The aim of these recommendations put together by the French-speaking Society for Clinical Nutrition and Metabolism (SFNCM)’s Home Artificial Nutrition Committee is to define in terms of healthcare resources the minimum care to provide to these patients. We also aim to help cope with the possible tensions, in order to secure the care we must provide to home artificial nutrition patients during this crisis.