scholarly journals Nutritional Management of Critically Ill Patients Infected with SARS-CoV-2

2021 ◽  
Vol 14 (01) ◽  
pp. 002-005
Author(s):  
Sérgio dos Anjos Garnes ◽  
Fernanda Lasakosvitsch ◽  
Adriana Bottoni ◽  
Andrea Bottoni
Keyword(s):  
Mechanical Ventilation ◽  
Severe Acute Respiratory Syndrome ◽  
Clinical Outcome ◽  
Critically Ill ◽  
Prone Position ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
Nutritional Therapy ◽  
Nutritional Management

AbstractEarly nutritional therapy is essential to ensure the maintenance of adequate energy/protein intake for critically ill patients infected with severe acute respiratory syndrome caused by COVID-19 (SARS-CoV-2) infection. However, this poses a major challenge when it comes to individuals on mechanical ventilation in prone position. Therefore, the present work presents a nutritional therapy flowchart developed for patients with SARS-CoV-2 infection to guide nutritional management and ensure that energy/protein intake goals are met, thus favoring a positive clinical outcome.

scholarly journals Nutritional Therapy in Critically Ill Patients with COVID-19: A Narrative Review

2021 ◽  
Vol 25 ◽  
pp. e1073
Author(s):  
Larissa Gens Guilherme
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Hospital Setting ◽  
Nutritional Therapy ◽  
Narrative Review ◽  
Current Evidence ◽  
High Association ◽  
Nutritional Recommendations ◽  
Improve Clinical Outcome

Introduction: Combating the pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), better known as Coronavirus Disease 2019 (COVID-19), in all countries of the world has been a challenge. Most patients can be treated in home isolation, however elderly patients and/or with associated comorbidities have been demonstrating more severe conditions of the disease, requiring hospitalization, or even nutritional therapy and mechanical ventilation. Objective: To review the current evidence to establish better nutritional recommendations for critically ill patients with COVID-19.Material and methods:This is a narrative review on nutritional therapy in critical patient with COVID-19. The scientific articles were searched in the databases U.S. National Library of Medicine (PubMed), as well as their respective terms in Portuguese and Spanish, and 40 articles were chosen, excluding the guidelines that were used to help better compose this article.Results: The main findings were that age and non-communicable diseases are considered risk factors for mortality, with systemic arterial hypertension and diabetes mellitus being the main ones. These patients need special care, as well as constant assessment of nutritional status, since malnourished and obese patients have shown a high association with mortality and the use of mechanical ventilation. Nutritional therapy in the affected patients can improve clinical outcome and should be considered as first-line treatment and be more valued in the hospital setting. Although there is no recommendation for supplementation of vitamin C and D and the mineral zinc, these may bring benefits to the immune system of these patients and help in a better prognosis of COVID-19, however more studies are still needed to substantiate the dosage.Conclusions: Further studies are needed, but it is important to bring these themes already exposed by some authors to stimulate discussions that might lead to improvements in the standardization of nutritional approaches.

scholarly journals Feasibility, tolerance and effectiveness of enteral feeding in critically ill patients in prone position

2020 ◽  
pp. 175114371990010 ◽  
Author(s):  
Raymond Dominic Savio ◽  
Rajalakshmi Parasuraman ◽  
Daphnee Lovesly ◽  
Bhuvaneshwari Shankar ◽  
Lakshmi Ranganathan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Prone Position ◽  
Supine Position ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Apache Ii ◽  
Apache Ii Score ◽  
The Mean

Aim To assess the feasibility, tolerance and effectiveness of enteral nutrition in critically ill patients receiving invasive mechanical ventilation in the prone position for severe Acute Respiratory Distress Syndrome (ARDS). Methods Prospective observational study conducted in a multidisciplinary critical care unit of a tertiary care hospital from January 2013 until July 2015. All patients with ARDS who received invasive mechanical ventilation in prone position during the study period were included. Patients’ demographics, severity of illness (Acute Physiology and Chronic Health Evaluation (APACHE II) score), baseline markers of nutritional status (subjective global assessment (SGA) and body mass index), details of nutrition delivery during prone and supine hours and outcomes (Length of stay and discharge status) were recorded. Results Fifty-one patients met inclusion criteria out of whom four patients were excluded from analysis since they did not receive any enteral nutrition due to severe hemodynamic instability. The mean age of patients was 46.4 ± 12.9 years, with male:female ratio of 7:3. On admission, SGA revealed moderate malnutrition in 51% of patients and the mean APACHE II score was 26.8 ± 9.2. The average duration of prone ventilation per patient was 60.2 ± 30.7 h. All patients received continuous nasogastric/orogastric feeds. The mean calories (kcal/kg/day) and protein (g/kg/day) prescribed in the supine position were 24.5 ± 3.8 and 1.1 ± 0.2 while the mean calories and protein prescribed in prone position were 23.5 ± 3.6 and 1.1 ± 0.2, respectively. Percentage of prescribed calories received by patients in supine position was similar to that in prone position (83.2% vs. 79.6%; P = 0.12). Patients received a higher percentage of prescribed protein in supine compared to prone position (80.8% vs. 75%, P = 0.02). The proportion of patients who received at least 75% of the caloric and protein goals was 37 (78.7%) and 37 (78.7%) in supine and 32 (68.1%) and 21 (44.6%) in prone position. Conclusion In critically ill patients receiving invasive mechanical ventilation in the prone position, enteral nutrition with nasogastric/orogastric feeding is feasible and well tolerated. Nutritional delivery of calories and proteins in prone position is comparable to that in supine position.

scholarly journals Timing of PROTein INtake and clinical outcomes of adult critically ill patients on prolonged mechanical VENTilation: The PROTINVENT retrospective study

2019 ◽  
Vol 38 (2) ◽  
pp. 883-890 ◽  
Author(s):  
W.A.C. (Kristine) Koekkoek ◽  
C.H. (Coralien) van Setten ◽  
Laura E. Olthof ◽  
J.C.N. (Hans) Kars ◽  
Arthur R.H. van Zanten
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Study ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
Prolonged Mechanical Ventilation

scholarly journals Nutrição enteral precoce e desfechos clínicos em pacientes de terapia intensiva

2021 ◽  
Vol 4 (35) ◽  
pp. 377-383
Author(s):  
Janaína da Conceição Fernandes Gama ◽  
Renata Quele Viana Silva ◽  
Anne Caroline Brito Barroso ◽  
Luiz Gustavo Vieira Cardoso ◽  
Matheus Lopes Cortes ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutritional Therapy ◽  
Nutritional Risk ◽  
Icu Stay ◽  
Enteral Diet ◽  
Mechanical Ventilation Time ◽  
Protein Supply

Introduction: Early nutritional support is a therapeutic strategy in critically ill patients, however, it has been shown to be controversial in relation to clinical outcomes. The aim of the study was to investigate the effects of early enteral nutritional therapy (ENT) and the initial caloric-protein supply on the clinical outcomes of patients in Intensive Care Units (ICU) of a hospital in Southwest Bahia. Methods: Prospective cohort study approved by the ethics committee. Information was collected on nutritional screening, anthropometric assessment, estimated nutritional needs and nutritional goals. The time of introduction of NET was classified as early, when started in the first 48 hours of admission and late. The volume and characteristics of the enteral diet were monitored daily, as well as the length of stay in the ICU and mechanical ventilation and mortality. Patients were followed up until discharge from the ICU or death. To test the association between the outcomes of mechanical ventilation time and ICU stay and nutritional variables, linear regression was used, while, for mortality, logistic regression. Results: 88 patients were included, of which 96.6% had nutritional risk at admission, determined by the severity of the condition. Early NET was received by 67 patients, with a mean of 39 ± 11.69 hours to onset and significant variation in relation to late NET (77.76 ± 32.11 hours), with no association with outcomes. The caloric and protein averages received in the first three days of NET were significantly higher in the early NET group (p = 0.000), which were associated with longer ICU stays and mechanical ventilation, even with a high frequency of protein inadequacy. No late ENT patient presented protein adequacy until the third day. Conclusion: Early NET was not associated with the clinical outcomes of critically ill patients, however, the greater energy supply increased the ICU stay and mechanical ventilation times.

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