Feeding practises and REE in critically ill COVID-19 patients

ABSTRACT

Rationale The optimal feeding strategy in critically ill COVID-19 patients is challenging. They seem particularly difficult to feed enterally, presenting with high gastric residual volumes (GRV) and diarrhoea. Our aim was to describe feeding practises and measured resting energy expenditure (mREE) during the acute and late phases of critical illness. Methods: Observational study including critically ill mechanically ventilated adult COVID-19 patients. Indirect calorimetry (IC;Q-NRG+) was used to determine mREE during the acute (day 1-7) and late phase (> day 7) of critical illness. Data on enteral nutrition (EN) and parenteral nutrition (PN) were collected on the same day. Comparison of mREE and predicted REE (pREE) (mREE/pREE *100%) was performed to explore hypometabolism (<90%) and hypermetabolism (>110%). In both phases parameters for intolerance to EN were collected on consequent days such as GRV (mL/d), vomiting, abdominal distention and diarrhoea. Results: We enrolled 35 patients in whom 42 IC measurements were performed (20 acute phase;22 late phase). Median age 63 year [IQR 47-69], 80% male. BMI upon admission was 27.8 kg/m2 [IQR 24.2-34.0], 43% obese (BMI>30 kg/m2). During the acute phase mREE was 1956 kcal [IQR 1846-2441] and respiratory quotient (RQ) 0,72 [IQR 0,67-0,81];10% was hypometabolic, 60% hypermetabolic. The median delivery of energy was 64% of mREE. All patients received EN;70% via nasogastric tube (NGT) and 30% via nasoduodenal tube (NDT). Median GRV was 195 mL/d [IQR 41-450], 5% vomited, 5% abdominal distention and 20% diarrhoea. In the late phase mREE was 2374 kcal [IQR 1828-2711] and RQ 0,81 [IQR 0,74-0,86];9% was hypometabolic and 68% hypermetabolic. The median delivery of energy was 92% of mREE. All patients except one received EN;50% NGT and 50% NDT, with a median GRV of 48 mL/d [IQR 15-180]. A total of 5% vomited, 9% abdominal distention and 15% diarrhoea. Conclusion: In both the acute and late phase the majority of the patients were hypermetabolic. Almost all patients were fed enterally, with a slightly higher presence of EN intolerance parameters during the acute phase. In the acute phase patients were fed hypocaloric whereas in the late phase this was almost normocaloric (64% vs 92% of mREE) conform our ESPEN based nutrition protocol. Elaborate data analysis are planned and will be presented at the conference. Disclosure of Interest None declared