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 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 Calculating minimum nutrition requirements in ICU patients

2020 ◽  
Author(s):  
Indubala Maurya ◽  
Ram Gopal Maurya
Keyword(s):  
Mechanical Ventilation ◽  
Wound Healing ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Current Evidence ◽  
Weaning From Mechanical Ventilation ◽  
Negative Outcomes ◽  
Icu Patients

Critically ill patients frequently receive inappropriate nutrition leading to underfeeding or overfeeding. This is associated with negative outcomes such as poor wound healing, difficulty in weaning from mechanical ventilation and an increase in mortality. This is due to due to lack of standard and appropriate formulas for calorie and protein calculation. We reviewed current evidence and recommendations for the minimum nutrition requirement for ICU patients. Received: 6 Oct 2018Reviewed: 16 Oct 2018Corrected: 28 Oct 2018Accepted: 05 Nov 2018 Citation: Maurya I, Maurya RG. Calculating minimum nutrition requirements in ICU patients Anaesth Pain & Intensive Care 2018;22 Suppl 1:S106-S108

The Role of Long-Term Ventilator Hospitals

2014 ◽  
Author(s):  
Jeremy M Kahn
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Acute Care ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation ◽  
Acute Care Hospitals ◽  
Cost Of Care ◽  
Current Evidence ◽  
Chronically Critically Ill

Long-term ventilator facilities play an increasingly important role in the care of chronically critically ill patients in the recovery phase of their acute illness. These hospitals can take several forms, depending on the country and health system, including �step-down� units within acute care hospitals and dedicated centres that specialize in weaning patients from prolonged mechanical ventilation. These hospitals may improve outcomes through increased clinical experience at applying protocolized weaning approaches and specialized, multidisciplinary, rehabilitation-focused care; they may also worsen outcomes by fragmenting the episode of acute care across multiple hospitals, leading to communication delays and hardship for families. Long-term ventilator facilities may also have important �spillover effects�, in that they free ICU beds in acute care hospitals to be filled with greater numbers of acute critically ill patients. Current evidence suggests that mortality of chronically critically ill patients is equivalent between acute care hospitals and specialized weaning centres; however, mechanical ventilation may be longer and cost of care higher in patients who remain in acute care hospitals. Given the rising incidence of prolonged mechanical ventilation and capacity constraints on acute care ICUs, long-term ventilator hospitals are likely to serve a key function in critical illness recovery.

scholarly journals Brain natriuretic peptide to predict successful liberation from mechanical ventilation in critically ill patients: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e022600
Author(s):  
Jean Deschamps ◽  
Jordan Webber ◽  
Robin Featherstone ◽  
Meghan Sebastianski ◽  
Ben Vandermeer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Statistical Analysis ◽  
Brain Natriuretic Peptide ◽  
Critically Ill ◽  
Natriuretic Peptide ◽  
Critically Ill Patients ◽  
Predictive Value ◽  
Meta Analysis ◽  
Current Evidence

IntroductionPredicting successful liberation from mechanical ventilation (MV) among critically ill patients receiving MV can be challenging. The current parameters used to predict successful extubation have shown variable predictive value. Brain natriuretic peptide (BNP) has been proposed as a novel biomarker to help guide decision-making in readiness for liberation of MV following a spontaneous breathing trial (SBT). Current evidence on the predictive ability of BNP has been uncertain, and BNP has not been integrated into clinical practice guidelines.Methods and analysisWe will perform a systematic review and meta-analysis to evaluate the value of BNP during SBT to predict success of liberation from MV. A search strategy will be developed in collaboration with a research librarian, and electronic databases (MEDLINE, EMBASE, Cochrane Library, Web of Science) and additional sources will be searched. Search themes will include: (1) BNP and (2) weaning, extubation and/or liberation from MV. Citation screening, selection, quality assessment and data abstraction will be performed in duplicate. The primary outcome will be liberation from MV; secondary outcomes will include time to reintubation, mortality, MV duration, total and postextubation intensive care unit (ICU) stay, hospitalisation duration, tracheostomy rate, ICU-acquired weakness rate and ventilator-free days. Primary statistical analysis will include predictive value of BNP by receiver operating characteristic curve, sensitivity/specificity and likelihood ratios for combination of BNP and SBT parameters for failure of liberation from MV. Secondary statistical analysis will be performed on individual and combinations of extracted metrics.Ethics and disseminationOur review will add knowledge by mapping the current body of evidence on the value of BNP testing for prediction of successful liberation from MV, and describe knowledge gaps and research priorities. Our findings will be disseminated through peer-reviewed publication, presentation at a scientific congress, through regional/national organisations and social media. Research ethics approval is not required.PROSPERO registration numberCRD42018087474.

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.

scholarly journals Tocilizumab for the Critically Ill With Severe COVID-19: A Community Hospital Case Series

2021 ◽  
pp. 089719002110023
Author(s):  
Matt G. McKenzie ◽  
Yeunju (Michelle) Lee ◽  
Julin Mathew ◽  
Megan Anderson ◽  
Alison T. Vo ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Community Hospital ◽  
Hospital Setting ◽  
Case Series ◽  
Community Hospitals ◽  
Retrospective Case ◽  
The Mean ◽  
Present On Admission

Objective: To evaluate the use of tocilizumab in a community hospital setting for critically ill patients with severe COVID-19. Design: A retrospective case series Setting: Five community hospitals within 1 urban health system Patients: Adult patients whom received tocilizumab between March 27th, 2020 to April 30th, 2020 for severe COVID-19. Interventions: None. Measurements and Main Results Sixteen patients in total were evaluated from the 5 community hospitals. The mean (± SD) age of the patients was 53.9 ± 9.2 years, 56% were men, and the most common comorbidities present on admission were hypertension (31%) and diabetes mellitus (25%). All patients received at least 1 other treatment modality for COVID-19 (steroids, hydroxychloroquine, or convaslescent plasma). Additionally, all patients on admission to intensive care units had severe COVID-19 with 56% requiring mechanical ventilation with a pre-tocilizumab median (IQR) Pao2: Fio2 of 84 (69 – 108.6), 19% requiring vasopressor support, and inflammatory markers (CRP, LDH, ferritin, and IL-6) were elevated. The median (IQR) tocilizumab dose was 400 mg (400-600) which correlated with a weight-based mean (± SD) dose of 5.4 mg/kg ± 1.3. Of the 16 patients that received tocilizumab, 8 (50%) were discharged home, 7 (44%) died, and 1 (6%) was still hospitalized at the end of data collection. Patients who died were more likely to be older 62 ± 2 years, female (57%), had a higher rate of mechanical ventilation (86%) and vasopressors (43%) use at baseline, and had a higher median (IQR) IL-6 level prior to tocilizumab administration 550 pg/mL (IQR 83-1924). There were no reported adverse drug reactions reported after the administration of tocilizumab for any patient. Conclusions: Our findings do not support the effectiveness of tocilizumab in treatment of severe COVID-19 infection in critically ill patients.

Levosimendan to facilitate weaning from cardiorespiratory support in critically ill patients: current evidence and future directions

2020 ◽  
Vol 86 (6) ◽  
Author(s):  
Fabio Sangalli ◽  
Giacomo Bellani ◽  
Alessandro Affronti ◽  
Francesca Volpi ◽  
Marco Feri ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Current Evidence ◽  
Future Directions

scholarly journals Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Eleni Papoutsi ◽  
Vassilis G. Giannakoulis ◽  
Eleni Xourgia ◽  
Christina Routsi ◽  
Anastasia Kotanidou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
All Cause Mortality ◽  
Detectable Difference

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

scholarly journals Effectiveness of anaesthesia ventilator use for mechanical ventilation in critically ill patients during the COVID-19 pandemic

2021 ◽  
Author(s):  
Aurélie GOUEL-CHERON ◽  
Yoann ELMALEH ◽  
Camille COUFFIGNAL ◽  
Elie KANTOR ◽  
Simon MESLIN ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients
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