ABSTRACT
Adequate protein and energy provision in critical care is associated with better clinical outcomes. The aim of this audit was to evaluate compliance with achieving recommended protein and energy targets in our Intensive Care Unit (ICU) and to explore the reasons for any deficits identified. Nutrition parameters were collected on patients admitted to our ICU between March and May 2021. Inclusion criteria were requirement for nutritional support and mechanical ventilation with an ICU length of stay ≥ 4 days. Patients with COVID19 were excluded. Protein and energy intakes were compared to best practice guidelines1. 51 patients met the inclusion criteria: 53% male, 47% female. Mean age was 59.6 years and mean length of stay was 19.9 days (range 5-61 days). Protein and energy intakes achieved as follows: [Formula presented] Of the patients who received < 80% of their nutritional requirements, the main barriers to achieving targets identified were fasting and constipation in this cohort. Cumulative deficit ranged from 0 - 903g protein and 0 - 12717kcal over duration of ICU stay. Mean deficit was 315g protein and 2945kcal. Of concern, 12 patients had a deficit of > 500g protein and 7 patients had > 5000kcal deficit. While 69% of patients met ≥ 80% protein requirements and 77% of patients met ≥ 80% energy requirements, we have identified areas to consider to improve nutritional adequacy including increasing awareness of minimising fasting times and the introduction of a bowel management protocol. References 1. Singer P, Blaser AR, Berger MM. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019 1;38(1):48-79. Disclosure of Interest: None Declared
ABSTRACT
Patients recovering from COVID-19 infection are at a high risk of malnutrition, reduced nutritional intake and decline in muscle mass and strength.1 The aim of this service evaluation is to describe baseline characteristics, quantify risk of malnutrition, provide an overview of nutritional status and nutritional related outcomes for patients recovering post COVID-19 infection on rehabilitation wards. Data collection occurred between the 1st of February and the 1st of July 2021. This cohort included all patients who were recovering from COVID-19, who were referred to dietetic service and transferred to a rehabilitation ward. Demographic data and nutritional parameters were gathered from electronic records, and dietetic assessments. A total of 54 patients were included: 59% male, 41% female. Ages ranged from 46 to 95 years with average age of 79.9 years and average length of hospital stay of 92 days. One fifth of those included had an ICU stay. Where data was available on sarcopenia risk, 50% were identified as at risk of sarcopenia. Of those where serum 25-hydroxyvitamin D was checked, 45% had insufficient vitamin D levels. A nutrition focused physical exam was completed for 18 patients (one third of the cohort). Using this exam, 61% were diagnosed with moderate or severe malnutrition. At least 15% of patients experienced significant weight loss between their admission to the hospital compared to their weight on admission to post COVID-19 rehabilitation ward. Of those where Malnutrition Screening Tool was completed on admission to COVID-19 rehabilitation ward, 33% were identified as at risk of malnutrition. On discharge from the dietetic caseload, the proportion of those identified at risk of malnutrition using this tool decreased to 18%. During the period from admission to COVID-19 rehabilitation ward and discharge from dietetic service, 42% gained weight, 54% maintained their weight, 4% lost weight. Of those with data available regarding nutritional intake on admission to COVID-19 rehabilitation ward, 28% met energy requirements and 44% met protein requirements. On discharge from dietetic service these proportions increased to 66% meeting energy requirements and 74% meeting protein requirements. The average kcal intake on admission to COVID-19 rehabilitation increased from 1531kcal to 1778kcal on discharge and the average protein intake increased from 67g on admission to post COVID-19 rehabilitation to 75g on discharge. These results demonstrate the high prevalence of malnutrition and high risk of sarcopenia in patients admitted for rehabilitation post COVID-19 infection. With dietetic input, improvements were observed in patient’s nutritional intake, and nutritional outcomes such as weight and malnutrition risk. These results illustrate the need for early dietetic input in those recovering post COVID-19 infection to optimise nutritional status and nutritional outcomes. References: 1. Anker M. S., Landmesser U., von Haehling S et al. Weight loss, malnutrition, and cachexia in COVID-19: facts and numbers. Journal of Cachexia, Sarcopenia and Muscle, 12, 9– 13.