Potential benefits of using an energy-dense, high-protein formula enriched with ß-hydroxy-ß-methylbutyrate, fructo-oligosaccharide, and vitamin D for enteral feeding in the ICU: A pilot case-control study in COVID-19 patients.

OBJECTIVES: The aim of this study was to investigate the potential benefits of using an energy-dense, high-protein (HP) formula enriched with ß-hydroxy-ß-methylbutyrate (HMB), fructo-oligosaccharide (FOS), and vitamin D (VitD) for enteral feeding in the intensive care unit (ICU). METHODS: This was a nested case-control multicenter study. Mechanically ventilated patients with COVID-19 in whom enteral nutrition was not contraindicated and receiving an energy-dense, HP-HMB-FOS-VitD formula (1.5 kcal/mL; 21.5% of calories from protein; n = 53) were matched (1:1) by age (±1 y), sex, body mass index (±1 kg/m2) and Sequential Organ Failure Assessment score (±1 point) and compared with patients fed with a standard HP, fiber-free formula (1.25-1.3 kcal/mL; 20% of calories from protein; n = 53). The primary end point was daily protein intake (g/kg) on day 4. Protein-calorie intake on day 7, gastrointestinal intolerance, and clinical outcomes were addressed as secondary end points. RESULTS: The use of a HP-HMB-FOS-VitD formula resulted in higher protein intake on days 4 and 7 (P = 0.006 and P = 0.013, respectively), with similar energy intake but higher provision of calories from enteral nutrition at both times (P <0 .001 and P = 0.017, respectively). Gastrointestinal tolerance was superior, with fewer patients fed with a HP-HMB-FOS-VitD formula reporting at least one symptom of intolerance (55 versus 74%; odds ratio [OR], 0.43; 95% confidence interval [CI], 0.18-0.99; P = 0.046) and constipation (38 versus 66%; OR, 0.27; 95% CI, 0.12-0.61; P = 0.002). A lower rate of ICU-acquired infections was also observed (42 versus 72%; OR, 0.29; 95% CI, 0.13-0.65; P = 0.003), although no difference was found in mortality, ICU length of stay, and ventilation-free survival. CONCLUSIONS: An energy-dense, HP-HMB-FOS-VitD formula provided a more satisfactory protein intake and a higher provision of caloric intake from enteral nutrition than a standard HP formula in mechanically ventilated patients with COVID-19. Lower rates of gastrointestinal intolerance and ICU-acquired infections were also observed.

Prevalence of Post Traumatic Stress Disorder, Anxiety and Depression among COVID-19 survivors 1 year after Intensive Care discharge.

BACKGROUND: Survivors of Intensive Care are known to be at increased risk of developing longer-term psychopathology issues. AIM: The aim of this study was to determine the prevalence of posttraumatic stress disorder, anxiety and depression among COVID-19 survivors 1 year after discharge from an Italian Intensive Care Unit (ICU). METHODS: We conducted a cross-sectional study between April and August 2021 among 86 adults COVID-19 survivors in Lecco (Italy). The PTSD was measured using the PTSD-checklist (PCL), HADS scale was used to measure anxiety and depression. Chi-square test or Fisher exact two-tailed tests were used to test for associations and the multiple logistic regressions model to determine factors that were independently associated with the outcome variables. RESULTS: The mean PTSD, anxiety and depression scores were (38.6 6.3), (5.1 3.8), (6.9 3.7) respectively. Based on cut-off scores, the prevalence of PTSD (PCL ≥ 45), anxiety (HADs score ≥ 8) and depression (HADs score ≥ 8) were (n = 20, 23.2%) (n = 22, 25.6%) and (n = 38, 44.2%) respectively. COVID-19 survivors who experienced a decreased level of exercise post-ICU discharge were more likely to show symptoms of depression (AOR = 2.57; 95%CI: 1.31-6.85, p = 0.027) and anxiety (AOR = 3.19; 95%CI: 1.29-8.32, p = 0.021) compared to those whose exercise remained the same post-ICU discharge. In addition Older COVID survivors were more likely to show symptoms of depression (AOR = 8.2, 95% CI: 1.97-24.45, p = 0.001) and anxiety (AOR = 3.26; 95%CI: 1.12-8.1, p = 0.022) compared to younger ones. CONCLUSIONS: Our findings show that PTSD, anxiety and depression are common among the COVID-19 survivors in Lecco. NURSING IMPLICATIONS: Nurses play a key role in the public health response to such crises, delivering direct patient care and reducing the risk of exposure to the infectious disease.

[Nosocomial infections during the COVID-19 outbreak. Observational study in an Italian ICU]. / Infezioni nosocomiali durante l'epidemia di COVID-19. Studio osservazionale in una Terapia Intensiva Italiana.

. Nosocomial infections during the COVID-19 outbreak. Observational study in an Italian ICU. INTRODUCTION: Infections are common among ICU patients. AIM: The purpose of this study is to examine the incidence of nosocomial infections among patients admitted to the ICU with SARS-CoV-2 infection. METHODS: A prospective observational study in adults with confirmed SARS-CoV-2 infection requiring intensive care unit (ICU) admission was performed. From May 2020 to October 2021, a total of 109 admitted patients were included. RESULTS: The incidence rate of new infections was 39.4%. The main infections observed were multidrug-resistant germs infections (39.5%), catheter-related blood infections(24.4%), pneumonia (VAP)(18.6%), and urinary tract infections (17.4%). The overall mortality rate was 32.1% (n= 35) and was significantly higher in patients who had a new infection during hospitalization (n= 26/43, 60.4%) than in patients who did not have a new infection (n= 9/66, 13.6%) (RR = 4.43; 95% CI = 2.31-8.52; p <.001). CONCLUSIONS: Our data suggest that secondary infections are associated with a longer duration of mechanical ventilation and hospital stay and may negatively impact patient survival. However, larger studies are needed.

Co-infections in critically ill adults with severe acute respiratory syndrome coronavirus 2 infection. An italian multi-centre prospective study.

BACKGROUND: To date, few studies have described Hospital-acquired infections (HAIs) during COVID-19 outbreak. To examine the incidence of HAIs in critically ill adult patients with SARS-COV-2 infection and to observe risk factors, and the impact on outcome of HAI. METHODS: A prospective multicenter study was conducted that included adult patients with SARS-COV-2 infection admitted to 18 Italian Intensive Care Units from September 2020 to November 2021. RESULTS: A total of 589 patients were included. A total of 233 patients were diagnosed with at least 1 HAI (39.6%). The co-infection/co-colonisation rate > 48 hours after admission was 31.0 per 1,000 person-days (95% CI 18.8 - 34.8). Age, length of ICU stay > 7 days, obesity, type 2 diabetes mellitus, cardiovascular disease, inserted central venous catheter, intubation, APACHE II score > 25, mechanical ventilation (MV) > 48 hours, obesity and inserted urinary catheter are associated outcomes for infection aquisition. The overall mortality rate of patients was found to be significantly higher in patients who had acquired a HAI (RR= 4.37; 95% CI = 3.30 - 5.78; p < .001). CONCLUSIONS: Associated factors for HAI acquisition and mortality in ICU patients were identified and cause for revision of existing infection control policies.