Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 17 de 17
Filter
1.
Clinical Nutrition ESPEN ; 48:513, 2022.
Article in English | EMBASE | ID: covidwho-2003967

ABSTRACT

The aim of this analysis was to determine nutrition support needs and characteristics of COVID19 patients assessed by critical care dietitians during the COVID19 pandemic. Nutrition parameters were collected for all patients admitted to the intensive care unit (ICU) with COVID19 with length of stay (LOS) >48hrs. Data was compared from March-June 2020 (T1) to January-April 2021 (T2). The patients who met the inclusion criteria (n=64 in T1 and n=77 in T2) were assessed by a critical care Dietitian: 100% required nutrition support. Mean age in T1 was 60.6yrs (66% male) compared to 63.1yrs in T2 (62% male). Mean BMI was 29.6kg/m2 vs. 30.2kg/m2. In T1 72% required mechanical ventilation vs. 78% in T2, remainder on non-invasive ventilation (NIV). Average ICU LOS was 16days in T1 and 25days in T2. During T1 78% transferred to ward level care, 48% in T2 and all these patients required on going dietetic input at ward level. In T1 41% were discharged from ICU on enteral nutrition which increased to 48% in T2. Type of nutrition support during ICU stay is described in the table below. [Formula presented] All COVID19 patients with and ICU LOS >48hours were assessed by a critical care Dietitian. Patient profile was similar in both cohorts and all required nutrition support either by ONS, EN, PN or a combination of these. All patients on NIV required ONS with increasing numbers being commenced on supplementary EN in T2. More patients also required supplementary PN in T2. On transfer to ward level care 100% of patients required nutrition support highlighting the need for on-going dietetic input. Disclosure of Interest: None Declared

2.
Clinical Nutrition ESPEN ; 48:511, 2022.
Article in English | EMBASE | ID: covidwho-2003966

ABSTRACT

The aim of this analysis was to compare route and adequacy of nutrition support in patients with COVID19 admitted to an intensive care unit (ICU) between March-June 2020 (T1) compared to January-April 2021 (T2). Parameters related to nutrition support were collected from the records of all patients admitted to ICU with COVID19 with length of stay of ≥7days on mechanical ventilation requiring artificial nutrition support. Data was collected during the late acute phase which was defined as day 4-7 post intubation. Energy and protein intake was compared to calculated estimated nutritional requirements. 35 patients met the inclusion criteria in T1, 94% were on enteral nutrition (EN), 3% parenteral nutrition (PN) and 3% EN+PN. In T2, there were 54 patients (92% EN, 2% PN and 6% EN+PN). [Formula presented] Of patients who achieved <70% of energy and protein requirements in T1 (n=17) 35% had constipation or ileus and 47% had GI intolerance (high gastric residual volumes or vomiting). In T2 (n=19), 84% experienced constipation or ileus and 63% had GI intolerance. 35% of patients in T1 had hypernatraemia vs. 47% in T2 and 41% in T1 had hyperglycaemia vs. 100% in T2 despite only 12% and 32% of patients respectively having a history of diabetes. Despite a higher incidence of GI intolerance in T2, a statistically significant improvement in achieving energy targets was noted. Learning from T1 showed that where strategies to improve GI tolerance are unsuccessful supplementary PN should be considered without delay to optimise nutritional intake. There was a clinically significant trend in protein intake which may be attributed to prompt initiation of modular protein supplements or perhaps an earlier transition from fat-based sedation. Meeting protein requirements while preventing overfeeding remains a challenge in the ICU. Disclosure of Interest: None Declared

3.
Clinical Nutrition ESPEN ; 48:505, 2022.
Article in English | EMBASE | ID: covidwho-2003960

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

4.
Clinical Nutrition ESPEN ; 48:498, 2022.
Article in English | EMBASE | ID: covidwho-2003953

ABSTRACT

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

5.
Clinical nutrition ESPEN ; 48:498-498, 2022.
Article in English | EuropePMC | ID: covidwho-1755957
6.
Clinical nutrition ESPEN ; 48:511-511, 2022.
Article in English | EuropePMC | ID: covidwho-1755785
7.
Clinical nutrition ESPEN ; 48:513-513, 2022.
Article in English | EuropePMC | ID: covidwho-1755535
8.
Irish Journal of Medical Science ; 190(SUPPL 5):203-203, 2021.
Article in English | Web of Science | ID: covidwho-1576337
9.
Clinical Nutrition ESPEN ; 46:S650-S651, 2021.
Article in English | ScienceDirect | ID: covidwho-1540513
10.
Clinical Nutrition ESPEN ; 46:S645-S646, 2021.
Article in English | ScienceDirect | ID: covidwho-1540508
14.
Clinical Nutrition ESPEN ; 40:633, 2020.
Article in English | EMBASE | ID: covidwho-942981

ABSTRACT

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.

15.
Clinical Nutrition ESPEN ; 40:632-633, 2020.
Article in English | EMBASE | ID: covidwho-942980

ABSTRACT

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.

16.
Anaesthesia ; 76(2): 251-260, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-729297

ABSTRACT

It is now apparent that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19) will remain endemic for some time. Improved therapeutics and a vaccine may shorten this period, but both are far from certain. Plans must be put in place on the assumption that the virus and its disease will continue to affect the care of patients and the safety of staff. This will impact particularly on airway management due to the inherent risk to staff during such procedures. Research is needed to clarify the nature and risk of respiratory aerosol-generating procedures. Improved knowledge of the dynamics of SARS-CoV-2 infection and immunity is also required. In the meantime, we describe the current status of airway management during the endemic phase of the COVID-19 pandemic. Some controversies remain unresolved, but the safety of patients and staff remains paramount. Current evidence does not support or necessitate dramatic changes to choices for anaesthetic airway management. Theatre efficiency and training issues are a challenge that must be addressed, and new information may enable this.


Subject(s)
Airway Management/methods , COVID-19 , Pandemics , Anesthesia , Humans , Infection Control , Operating Rooms/organization & administration , Personal Protective Equipment
17.
Anaesthesia ; 75(11): 1437-1447, 2020 11.
Article in English | MEDLINE | ID: covidwho-591680

ABSTRACT

Healthcare workers involved in aerosol-generating procedures, such as tracheal intubation, may be at elevated risk of acquiring COVID-19. However, the magnitude of this risk is unknown. We conducted a prospective international multicentre cohort study recruiting healthcare workers participating in tracheal intubation of patients with suspected or confirmed COVID-19. Information on tracheal intubation episodes, personal protective equipment use and subsequent provider health status was collected via self-reporting. The primary endpoint was the incidence of laboratory-confirmed COVID-19 diagnosis or new symptoms requiring self-isolation or hospitalisation after a tracheal intubation episode. Cox regression analysis examined associations between the primary endpoint and healthcare worker characteristics, procedure-related factors and personal protective equipment use. Between 23 March and 2 June 2020, 1718 healthcare workers from 503 hospitals in 17 countries reported 5148 tracheal intubation episodes. The overall incidence of the primary endpoint was 10.7% over a median (IQR [range]) follow-up of 32 (18-48 [0-116]) days. The cumulative incidence within 7, 14 and 21 days of the first tracheal intubation episode was 3.6%, 6.1% and 8.5%, respectively. The risk of the primary endpoint varied by country and was higher in women, but was not associated with other factors. Around 1 in 10 healthcare workers involved in tracheal intubation of patients with suspected or confirmed COVID-19 subsequently reported a COVID-19 outcome. This has human resource implications for institutional capacity to deliver essential healthcare services, and wider societal implications for COVID-19 transmission.


Subject(s)
Betacoronavirus , Coronavirus Infections/transmission , Health Personnel , Intubation, Intratracheal , Occupational Exposure/adverse effects , Pneumonia, Viral/transmission , Adult , COVID-19 , Coronavirus Infections/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Proportional Hazards Models , Prospective Studies , Risk , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL