Nutrition Therapy in Critically Ill Patients With Coronavirus Disease 2019

Robert Martindale, Jayshil J. Patel, Beth Taylor, Yaseen M. Arabi, Malissa Warren, Stephen A. McClave

Research output: Contribution to journalReview articlepeer-review

14 Scopus citations

Abstract

In the midst of a coronavirus disease 2019 (COVID-19) pandemic, a paucity of data precludes derivation of COVID-19–specific recommendations for nutrition therapy. Until more data are available, focus must be centered on principles of critical care nutrition modified for the constraints of this disease process, ie, COVID-19–relevant recommendations. Delivery of nutrition therapy must include strategies to reduce exposure and spread of disease by providing clustered care, adequate protection of healthcare providers, and preservation of personal protective equipment. Enteral nutrition (EN) should be initiated early after admission to the intensive care unit (ICU) using a standard isosmolar polymeric formula, starting at trophic doses and advancing as tolerated, while monitoring for gastrointestinal intolerance, hemodynamic instability, and metabolic derangements. Intragastric EN may be provided safely, even with use of prone-positioning and extracorporeal membrane oxygenation. Clinicians should have a lower threshold for switching to parenteral nutrition in cases of intolerance, high risk of aspiration, or escalating vasopressor support. Although data extrapolated from experience in acute respiratory distress syndrome warrants use of fiber additives and probiotic organisms, the lack of benefit precludes a recommendation for micronutrient supplementation. Practices that increase exposure or contamination of equipment, such as monitoring gastric residual volumes, indirect calorimetry to calculate requirements, endoscopy or fluoroscopy to achieve enteral access, or transport out of the ICU for additional imaging, should be avoided. At all times, strategies for nutrition therapy need to be assessed on a risk/benefit basis, paying attention to risk for both the patient and the healthcare provider.

Original languageEnglish (US)
Pages (from-to)1174-1184
Number of pages11
JournalJournal of Parenteral and Enteral Nutrition
Volume44
Issue number7
DOIs
StatePublished - Sep 1 2020

Keywords

  • ARDS
  • COVID-19
  • enteral nutrition
  • nutrition ECMO
  • nutrition support teams
  • parenteral nutrition
  • sepsis

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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