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Nutritional Care in Relation to COVID-19

22 October 2020
Product Focus
02 October 2020
Volume 29 · Issue 19

Abstract

The following article was written after the initial wave of the COVID-19 pandemic in the UK. On reflection of clinical practice during this time, it was noted by the ICU team that the majority of ventilated patients appeared to have lost weight during their stay. Unfortunately, there was no ability to weigh patients during the pandemic, so this weight loss was a subjective observation. Regardless, this observation lead the ICU dietitian to retrospectively audit prescribed versus delivered feed.

It was found that only 10% of admissions received the prescribed daily volume of feed within the first 7 days of admission. A further 6% of admissions were within 10% of achieving daily prescribed target volumes. The main reasons for this were proning patients, high gastric residual volumes and the overwhelming nature of the pandemic.

Three areas of practice have been highlighted that will improve feed delivery should a second wave occur. 1. A nasojejunal team comprising 20 members of the ICU multidiciplinary team will be established to insert bedside nasojejunal tubes in all ICU patients on admission. 2. All proned patients will be enterally fed and practice adjusted as per British Dietetic Association recommendations. 3. The international enteral feeding guidelines regarding hypocaloric feeding for the first 7 days will not be followed due to minimal clinical evidence for the ICU COVID-19 demographic.

The COVID-19 pandemic presents extraordinary challenging times worldwide, in particular for patients and healthcare systems (Bouadma et al, 2020; Chen et al, 2020; Huang et al, 2020; Zhou et al, 2020; Zhu et al, 2020). The nature of the virus means it is highly contagious and spreads rapidly. Patients present with a range of symptoms including fever, dry cough, fatigue, loss of smell and taste, dyspnoea and myalgia (Li et al, 2020a; Wu and McGoogan, 2020; Xiao et al, 2020; Zhao et al, 2020). Many COVID-19 patients also present with acute respiratory complications requiring admissions to intensive care units (ICU). Prolonged ICU admissions secondary to COVID-19 respiratory complications have been major causes of morbidity and mortality, particularly in older adults (Bouadma et al, 2020; Chen et al, 2020; Huang et al, 2020; Zhu et al, 2020). The virus has also been shown to affect the gastrointestinal tract (GIT) (Cheung et al, 2020; Yeo et al, 2020; Xiao et al, 2020) and renal and neurological systems (Li et al, 2020b; Pei et al, 2020) It is well documented that prolonged ICU admissions are associated with a loss of muscle mass, reduced functional capacity and an increased risk of malnutrition, resulting in a reduced quality of life and increased morbidities (Singer et al, 2019).

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