Evolution of the nutritional status of COVID-19 critically-ill patients: A prospective observational study from ICU admission to three months after ICU discharge.

BACKGROUND & AIMS: Malnutrition following intensive care unit (ICU) stay is frequent and could be especially prominent in critically ill Coronavirus Disease 2019 (COVID-19) patients as they present prolonged inflammatory state and long length stay. We aimed to determine the prevalence of malnutrition in critically ill COVID-19 patients both at the acute and recovery phases of infection. METHODS: We conducted a prospective observational study including critically ill COVID-19 patients requiring invasive mechanical ventilation discharged alive from a medical ICU of a university hospital. We collected demographic, anthropometric and ICU stay data (SAPS2, recourse to organ support and daily energy intake). Nutritional status and nutritional support were collected at one month after ICU discharge (M1) by phone interview and at 3 months after ICU discharge (M3) during a specialized and dedicated consultation conducted by a dietitian. Malnutrition diagnosis was based on weight loss and body mass index (BMI) criteria following the Global Leadership Initiative on Malnutrition. Primary outcome was the prevalence of malnutrition at M3 and secondary outcomes were the evolution of nutritional status from ICU admission to M3 and factors associated with malnutrition at M3. RESULTS: From march 13th to may 15th, 2020, 38 patients were discharged alive from the ICU, median [IQR] age 66 [59-72] years, BMI 27.8 [25.5-30.7] kg/m2 and SAPS2 47 [35-55]. Thirty-three (86%) patients were followed up to M3. Prevalence of malnutrition increased during the ICU stay, from 18% at ICU admission to 79% at ICU discharge and then decreased to 71% at M1 and 53% at M3. Severe malnutrition prevailed at ICU discharge with a prevalence of 55% decreasing 32% at M3. At M3, the only factors associated with malnutrition in univariate analysis were the length of invasive mechanical ventilation and length of ICU stay (28 [18-44] vs. 13 [11-24] days, P = 0.011 and 32 [22-48] vs. 17 [11-21] days, P = 0.006, respectively), while no ICU preadmission and admission factors, nor energy and protein intakes distinguished the two groups. Only 35% of undernourished patients at M3 had benefited from a nutritional support. CONCLUSION: Malnutrition is frequent, protracted and probably underrecognized among critically ill Covid-19 patients requiring invasive mechanical ventilation with more than half patients still being undernourished three months after ICU discharge. A particular attention should be paid to the nutritional status of these patients not only during their ICU stay but also following ICU discharge.

A patchwork quilt of programs

How is Germany doing with respect to the fight against COVID-19? Did the German Federal and the country's Regional Governments enact a coordinated approach, and did the sector have the opportunity to co-operate with government and have a "voice" in the policy process? Based on the results of recent empirical studies and desk-top, internet-based research, these questions are addressed and the outcome is that there were numerous programs issued by the Federal and regional German governments that buffer the effects of the crisis is having on the sector. However, the programs were not developed in co-operation with the sector and were not easy to access, particularly for small and non-professionalized nonprofits. © 2021 De Gruyter. All rights reserved.

COVID-19 driven care changes in high risk patients from an outpa-tient to a community setting-a quality improvement survey

Background: COVID-19 has led to a change in care for patients with chronic conditions, involving a transfer of drug administration from an outpatient to a community setting. Aim : To investigate patient preferences for treatment settings in the light of the current pandemic. Methods : Patients, who prior to the pandemic had attended two differ-ent outpatient clinics in a university hospital for their infusions or injec-tions, were interviewed by telephone. The semi-structured interviews were analyzed using qualitative and quantitative methods. Results : Of the 49 participants with either anti-inflammatory or immu-noglobulin treatments, 49% switched from subcutaneous injections in the hospital to the community setting, 36.7% from intravenous infusions in the hospital to subcutaneous administration at home and 14.3% moved to intravenous infusions at home. During the pandemic 80.9% wanted to continue their treatment at home, but post the pandemic 46.8% were opting to go back to the hospital. Satisfaction was high with both settings, slightly favoring drug administration in hospital. Qualitative data shows that patients while emphasizing the importance of the relationship with the healthcare team had increased concerns about safety because of COVID-19. Conclusions : The pandemic introduced changes in care in our highly specific patient group, some of which might be positive. The COVID-19 pandemic served as a mirror in which we were able to review and reflect on our model of care. Asking patients about their preferences, including drug application setting, providing self-management support but also monitoring effectiveness and side effects, should be continued during a crisis and beyond and warrants long term follow-up.