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1.
Nutrients ; 14(5)2022 Mar 07.
Article in English | MEDLINE | ID: covidwho-1732149

ABSTRACT

BACKGROUND: Patients who are critically ill with COVID-19 could have impaired nutrient absorption due to disruption of the normal intestinal mucosa. They are often in a state of high inflammation, increased stress and catabolism as well as a significant increase in energy and protein requirements. Therefore, timely enteral nutrition support and the provision of optimal nutrients are essential in preventing malnutrition in these patients. AIM: This review aims to evaluate the effects of enteral nutrition in critically ill patients with COVID-19. METHOD: This systematic review and meta-analysis was conducted based on the preferred reporting items for systematic review and meta-Analysis framework and PICO. Searches were conducted in databases, including EMBASE, Health Research databases and Google Scholar. Searches were conducted from database inception until 3 February 2022. The reference lists of articles were also searched for relevant articles. RESULTS: Seven articles were included in the systematic review, and four articles were included in the meta-analysis. Two distinct areas were identified from the results of the systematic review and meta-analysis: the impact of enteral nutrition and gastrointestinal intolerance associated with enteral nutrition. The impact of enteral nutrition was further sub-divided into early enteral nutrition versus delayed enteral nutrition and enteral nutrition versus parenteral nutrition. The results of the meta-analysis of the effects of enteral nutrition in critically ill patients with COVID-19 showed that, overall, enteral nutrition was effective in significantly reducing the risk of mortality in these patients compared with the control with a risk ratio of 0.89 (95% CI, 0.79, 0.99, p = 0.04). Following sub-group analysis, the early enteral nutrition group also showed a significant reduction in the risk of mortality with a risk ratio of 0.89 (95% CI, 0.79, 1.00, p = 0.05). The Relative Risk Reduction (RRR) of mortality in patients with COVID-19 by early enteral nutrition was 11%. There was a significant reduction in the Sequential Organ Failure Assessment (SOFA) score in the early enteral nutrition group compared with the delayed enteral nutrition group. There was no significant difference between enteral nutrition and parenteral nutrition in relation to mortality (RR = 0.87; 95% CI, 0.59, 1.28, p = 0.48). Concerning the length of hospital stay, length of ICU stay and days on mechanical ventilation, while there were reductions in the number of days in the enteral nutrition group compared to the control (delayed enteral nutrition or parenteral nutrition), the differences were not significant (p > 0.05). CONCLUSION: The results showed that early enteral nutrition significantly (p < 0.05) reduced the risk of mortality among critically ill patients with COVID-19. However, early enteral nutrition or enteral nutrition did not significantly (p > 0.05) reduce the length of hospital stay, length of ICU stay and days on mechanical ventilation compared to delayed enteral nutrition or parenteral nutrition. More studies are needed to examine the effect of early enteral nutrition in patients with COVID-19.


Subject(s)
COVID-19 , Enteral Nutrition , COVID-19/therapy , Critical Illness/therapy , Enteral Nutrition/methods , Humans , Parenteral Nutrition/methods , SARS-CoV-2
2.
Nutrients ; 14(1)2021 Dec 29.
Article in English | MEDLINE | ID: covidwho-1580548

ABSTRACT

The outbreak of the new coronavirus strain SARS-CoV-2 (COVID-19) highlighted the need for appropriate feeding practices among critically ill patients admitted to the intensive care unit (ICU). This study aimed to describe feeding practices of intubated COVID-19 patients during their second week of hospitalization in the First Department of Critical Care Medicine, Evaggelismos General Hospital, and evaluate potential associations with all cause 30-day mortality, length of hospital stay, and duration of mechanical ventilation. We enrolled adult intubated COVID-19 patients admitted to the ICU between September 2020 and July 2021 and prospectively monitored until their hospital discharge. Of the 162 patients analyzed (52.8% men, 51.6% overweight/obese, mean age 63.2 ± 11.9 years), 27.2% of patients used parenteral nutrition, while the rest were fed enterally. By 30 days, 34.2% of the patients in the parenteral group had died compared to 32.7% of the patients in the enteral group (relative risk (RR) for the group receiving enteral nutrition = 0.97, 95% confidence interval = 0.88-1.06, p = 0.120). Those in the enteral group demonstrated a lower duration of hospital stay (RR = 0.91, 95% CI = 0.85-0.97, p = 0.036) as well as mechanical ventilation support (RR = 0.94, 95% CI = 0.89-0.99, p = 0.043). Enteral feeding during second week of ICU hospitalization may be associated with a shorter duration of hospitalization and stay in mechanical ventilation support among critically ill intubated patients with COVID-19.


Subject(s)
COVID-19/mortality , COVID-19/therapy , Critical Care/methods , Enteral Nutrition/statistics & numerical data , Parenteral Nutrition/statistics & numerical data , Respiration, Artificial/mortality , Critical Illness , Enteral Nutrition/methods , Enteral Nutrition/mortality , Female , Greece/epidemiology , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Parenteral Nutrition/methods , Parenteral Nutrition/mortality , Prospective Studies , Respiration, Artificial/methods , SARS-CoV-2 , Time Factors , Treatment Outcome
3.
Am J Nurs ; 121(8): 36-43, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1307559

ABSTRACT

ABSTRACT: Gastric tube feeding is a common and valuable intervention for patients in a variety of care settings. While tube feeding can save the lives of patients for whom oral feeding isn't possible, intolerance to tube feeding is a potential complication. This article discusses risk factors for feeding intolerance; the assessment of signs and symptoms of feeding intolerance; the various means of assessing gastric emptying, including the practice of monitoring gastric residual volume (GRV); the controversy surrounding GRV monitoring in assessing feeding tolerance; and the special considerations for monitoring feeding tolerance in acutely and critically ill adults with coronavirus disease 2019. The author, a nurse researcher with extensive experience in the area of enteral feeding, briefly summarizes recommendations and guidelines for enteral feeding published by national and international health care organizations between 2015 and 2020, and offers her perspective on best nursing practices for monitoring food tolerance in adults.


Subject(s)
Education, Continuing , Enteral Nutrition/nursing , Gastric Emptying/physiology , Critical Illness/nursing , Critical Illness/rehabilitation , Enteral Nutrition/instrumentation , Enteral Nutrition/methods , Guidelines as Topic , Humans
4.
Clin Nutr ; 40(3): 895-900, 2021 03.
Article in English | MEDLINE | ID: covidwho-1198670

ABSTRACT

There are reports of children COVID-19 or COVID-19 like symptoms with hyperinflammatory multisystem syndrome, ARDS, gastrointestinal and atypical Kawasaki disease presenting to PICU worldwide temporally associated with COVID-19, for which there are important nutrition support considerations. As a result, the European Society of Pediatric and Neonatal Intensive Care - Metabolism, Endocrine and Nutrition group (ESPNIC-MEN) and paediatric nutritionists working in PICUs are being consulted regarding nutrition management of critically ill children with COVID-19 or COVID-19 like symptoms. Therefore, the aim of this short report is to provide a summary of nutrition support recommendations for critically ill children with COVID-19. They are based on the ESPNIC-MEN section recommendations published in January 2020 and surviving sepsis recommendations from February 2020.


Subject(s)
COVID-19/therapy , Nutritional Support/methods , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/therapy , Child , Critical Care/methods , Critical Illness , Enteral Nutrition/methods , Humans , Intensive Care Units, Pediatric , Nutritional Status
6.
JPEN J Parenter Enteral Nutr ; 45(1): 13-31, 2021 01.
Article in English | MEDLINE | ID: covidwho-953809

ABSTRACT

The purpose of this scoping review by the American Society for Parenteral and Enteral Nutrition (ASPEN) Coronavirus Disease 2019 (COVID-19) Nutrition Task Force was to examine nutrition research applicable to the COVID-19 pandemic. The rapid pace of emerging scientific information has prompted this activity to discover research/knowledge gaps. This methodology adhered with recommendations from the Joanna Briggs Institute. There were 2301 citations imported. Of these, there were 439 articles fully abstracted, with 23 main topic areas identified across 24 article types and sourced across 61 countries and 51 specialties in 8 settings and among 14 populations. Epidemiological/mechanistic relationships between nutrition and COVID-19 were reviewed and results mapped to the Population, Intervention, Comparator, Outcome, and Time (PICO-T) questions. The aggregated data were analyzed by clinical stage: pre-COVID-19, acute COVID-19, and chronic/post-COVID-19. Research gaps were discovered for all PICO-T questions. Nutrition topics meriting urgent research included food insecurity/societal infrastructure and transcultural factors (pre-COVID-19); cardiometabolic-based chronic disease, pediatrics, nutrition support, and hospital infrastructure (acute COVID-19); registered dietitian nutritionist counseling (chronic/post-COVID-19); and malnutrition and management (all stages). The paucity of randomized controlled trials (RCTs) was particularly glaring. Knowledge gaps were discovered for PICO-T questions on pediatrics, micronutrients, bariatric surgery, and transcultural factors (pre-COVID-19); enteral nutrition, protein-energy requirements, and glycemic control with nutrition (acute COVID-19); and home enteral and parenteral nutrition support (chronic/post-COVID-19). In conclusion, multiple critical areas for urgent nutrition research were identified, particularly using RCT design, to improve nutrition care for patients before, during, and after COVID-19.


Subject(s)
COVID-19 , Dietetics , Pandemics , COVID-19/therapy , Enteral Nutrition/methods , Pandemics/prevention & control , Parenteral Nutrition/methods , SARS-CoV-2
8.
Nutr Clin Pract ; 35(5): 792-799, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-710161

ABSTRACT

Worldwide, as of July 2020, >13.2 million people have been infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. The spectrum of coronavirus disease 2019 (COVID-19) ranges from mild illness to critical illness in 5% of cases. The population infected with SARS-CoV-2 requiring an intensive care unit admission often requires nutrition therapy as part of supportive care. Although the various societal guidelines for critical care nutrition meet most needs for the patient with COVID-19, numerous factors, which impact the application of those guideline recommendations, need to be considered. Since the SARS-CoV-2 virus is highly contagious, several key principles should be considered when caring for all patients with COVID-19 to ensure the safety of all healthcare personnel involved. Management strategies should cluster care, making all attempts to bundle patient care to limit exposure. Healthcare providers should be protected, and the spread of SARS-CoV-2 should be limited by minimizing procedures and other interventions that lead to aerosolization, avoiding droplet exposure through hand hygiene and use of personal protective equipment (PPE). PPE should be preserved by decreasing the number of individuals providing direct patient care and by limiting the number of patient interactions. Enteral nutrition (EN) is tolerated by the majority of patients with COVID-19, but a relatively low threshold for conversion to parenteral nutrition should be maintained if increased exposure to the virus is required to continue EN. This article offers relevant and practical recommendations on how to optimize nutrition therapy in critically ill patients with COVID-19.


Subject(s)
Coronavirus Infections/therapy , Critical Care/methods , Nutritional Support/methods , Patient Care Bundles/methods , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Betacoronavirus , COVID-19 , Critical Care/standards , Enteral Nutrition/methods , Enteral Nutrition/standards , Humans , Nutritional Support/standards , Pandemics , SARS-CoV-2
9.
Arch Dis Child ; 105(12): 1186-1191, 2020 12.
Article in English | MEDLINE | ID: covidwho-690253

ABSTRACT

BACKGROUND: COVID-19 has impacted on healthcare provision. Anecdotally, investigations for children with inflammatory bowel disease (IBD) have been restricted, resulting in diagnosis with no histological confirmation and potential secondary morbidity. In this study, we detail practice across the UK to assess impact on services and document the impact of the pandemic. METHODS: For the month of April 2020, 20 tertiary paediatric IBD centres were invited to contribute data detailing: (1) diagnosis/management of suspected new patients with IBD; (2) facilities available; (3) ongoing management of IBD; and (4) direct impact of COVID-19 on patients with IBD. RESULTS: All centres contributed. Two centres retained routine endoscopy, with three unable to perform even urgent IBD endoscopy. 122 patients were diagnosed with IBD, and 53.3% (n=65) were presumed diagnoses and had not undergone endoscopy with histological confirmation. The most common induction was exclusive enteral nutrition (44.6%). No patients with a presumed rather than confirmed diagnosis were started on anti-tumour necrosis factor (TNF) therapy.Most IBD follow-up appointments were able to occur using phone/webcam or face to face. No biologics/immunomodulators were stopped. All centres were able to continue IBD surgery if required, with 14 procedures occurring across seven centres. CONCLUSIONS: Diagnostic IBD practice has been hugely impacted by COVID-19, with >50% of new diagnoses not having endoscopy. To date, therapy and review of known paediatric patients with IBD has continued. Planning and resourcing for recovery is crucial to minimise continued secondary morbidity.


Subject(s)
COVID-19 , Child Health Services , Endoscopy, Gastrointestinal , Health Services Accessibility , Inflammatory Bowel Diseases , Tumor Necrosis Factor Inhibitors/therapeutic use , Adolescent , Ambulatory Care Facilities/statistics & numerical data , Ambulatory Care Facilities/supply & distribution , COVID-19/epidemiology , COVID-19/prevention & control , Child , Child Health Services/statistics & numerical data , Child Health Services/supply & distribution , Communicable Disease Control/methods , Endoscopy, Gastrointestinal/methods , Endoscopy, Gastrointestinal/statistics & numerical data , Enteral Nutrition/methods , Enteral Nutrition/statistics & numerical data , Female , Health Care Surveys , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Health Services Needs and Demand , Humans , Inflammatory Bowel Diseases/diagnosis , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/therapy , Male , SARS-CoV-2 , United Kingdom/epidemiology
10.
Nutr Hosp ; 34(3): 622-630, 2020 Jul 13.
Article in Spanish | MEDLINE | ID: covidwho-663764

ABSTRACT

INTRODUCTION: The current COVID-19 pandemic mainly affects older people, those with obesity or other coexisting chronic diseases such as type-2 diabetes and high blood pressure. It has been observed that about 20 % of patients will require hospitalization, and some of them will need the support of invasive mechanical ventilation in intensive care units. Nutritional status appears to be a relevant factor influencing the clinical outcome of critically ill patients with COVID-19. Several international guidelines have provided recommendations to ensure energy and protein intake in people with COVID-19, with safety measures to reduce the risk of infection in healthcare personnel. The purpose of this review is to analyze the main recommendations related to adequate nutritional management for critically ill patients with COVID-19 in order to improve their prognosis and clinical outcomes.


INTRODUCCIÓN: La pandemia actual por COVID-19 afecta principalmente a personas mayores, con obesidad o con otras enfermedades crónicas coexistentes como diabetes de tipo 2 e hipertensión arterial. Se ha observado que alrededor del 20 % de los pacientes requerirán hospitalización y algunos de ellos necesitarán soporte de ventilación mecánica invasiva en unidades de cuidados intensivos. El estado nutricional parece ser un factor relevante que influye en el resultado clínico de los pacientes con COVID-19 críticamente enfermos. Diversas guías internacionales han publicado recomendaciones para asegurar la ingesta energética y proteica de las personas con COVID-19, junto con medidas de seguridad para disminuir el riesgo de infección por parte del personal de salud. El propósito de esta revisión es analizar las principales recomendaciones relacionadas con el adecuado manejo nutricional del paciente hospitalizado críticamente enfermo con COVID-19 con la finalidad de mejorar el pronóstico y los resultados clínicos.


Subject(s)
Betacoronavirus , Coronavirus Infections/diet therapy , Critical Care/methods , Critical Illness , Malnutrition/diet therapy , Pandemics , Pneumonia, Viral/diet therapy , COVID-19 , Cardiovascular Diseases/epidemiology , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Dietary Proteins/administration & dosage , Enteral Nutrition/adverse effects , Enteral Nutrition/methods , Gastrointestinal Diseases/complications , Humans , Inflammation/epidemiology , Inflammation/physiopathology , Malnutrition/diagnosis , Malnutrition/etiology , Malnutrition/prevention & control , Meta-Analysis as Topic , Micronutrients/administration & dosage , Nutrition Assessment , Nutritional Requirements , Nutritional Support , Obesity/epidemiology , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Refeeding Syndrome/prevention & control , Respiration, Artificial , SARS-CoV-2 , Sarcopenia/epidemiology
11.
Nutr Clin Pract ; 35(5): 783-791, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-647092

ABSTRACT

Coronavirus disease 2019 (COVID-19) has changed nutrition care processes in hospitals and in the home setting. This paper summarizes clinician reports on these changed processes, including overall nutrition care, nutrition assessment, enteral nutrition and parenteral nutrition care steps, and food and oral supplement delivery. Also included are teaching, logistics, and personnel issues around changes in the work environment. Use of safe, standardized, evidence-based processes in the face of altered care patterns is critical.


Subject(s)
Coronavirus Infections/therapy , Dietetics/methods , Enteral Nutrition/methods , Nutrition Assessment , Parenteral Nutrition/methods , Pneumonia, Viral/therapy , Betacoronavirus , COVID-19 , Humans , Pandemics , SARS-CoV-2
13.
Clin Nutr ESPEN ; 38: 196-200, 2020 08.
Article in English | MEDLINE | ID: covidwho-325581

ABSTRACT

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a worldwide rapidly spreading illness, Coronavirus Disease 2019 (COVID-19). Patients fed enterally and parenterally at home are exposed to the same risk of infection as the general population, but more prone to complications than others. Therefore the guidance for care-givers and care-takers of these patients is needed. METHODS: The literature search identified no relevant systematic reviews or studies on the subject. Therefore a panel of 21 experts from 13 home medical nutrition (HMN) centres in Poland was formed. Twenty-three key issues relevant to the management of SARS-CoV-2 infection or COVID-19 in the HMN settings were identified and discussed. Some statements diverge from the available nutrition, surgical or ICU guidelines, some are based on the best available experience. Each topic was discussed and assessed during two Delphi rounds subsequently. Statements were graded strong or weak based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. RESULTS: the panel issued 23 statements, all of them were graded strong. Two scored 85.71% agreement, eleven 95.23%, and ten 100%. The topics were: infection control, enrolment to HMN, logistics and patient information. CONCLUSIONS: the position paper present pragmatic statements for HMN to be implemented in places without existing protocols for SARS-CoV-2 pandemic. They represent the state of knowledge available at the moment and may change should new evidence occurs.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Enteral Nutrition/methods , Home Care Services , Parenteral Nutrition/methods , Pneumonia, Viral/complications , COVID-19 , COVID-19 Testing , Caregivers/education , Clinical Laboratory Techniques , Consensus , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Delivery of Health Care , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Patient Care Team , Patient Isolation , Patient-Centered Care/methods , Personal Protective Equipment , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Risk Factors , SARS-CoV-2
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