COVID-19: ICU nutrition interventions highlights

Healthcare workers at every level are quickly learning about COVID-19 and how to use their expertise to best support patients and promote rapid recovery. Registered dietitians are among the essential healthcare professionals providing care to each and every patient. Nutrition guidelines for critically ill patients are well-established. But, what about specific nutrition recommendations for providing medical nutrition therapy to COVID-19 ICU patients? Here are some highlights of the recommendations from the American Society for Parenteral and Enteral Nutrition (ASPEN):

• Continue providing nutrition care consistent with existing critical care guidelines to ICU COVID-19 patients
• Initiate enteral nutrition if gut is functioning within 24 to 36 hours of admission or 12 hours of intubation
• Start enteral nutrition with a nasogastric tube
• Initiate with hypocaloric feedings using 15 to 20 kcal/kg and 1.2 to 2 g/kg protein
• Start with continuous feedings of high protein, polymeric formula, if able
• Adapt to product and supply shortages such as using alterative enteral nutrition formulas and using gravity pumps or bolus feeds
• Minimize patient contact by keeping pumps outside of rooms by using additional tubing and clustering nutrient administration as much as possible
• Feed patients in the prone position—enteral nutrition is still appropriate with head of bed elevated 10 to 15 degrees
• If you’re not allowed to physically see the patient, call a colleague on the unit who is physically seeing the patient, and ask about nutrition support administration instead of solely relying on the medical record
• Lower the threshold of initiating parenteral nutrition for COVID-19 patients
• Initiate parenteral nutrition early for ICU patients if GI intolerance is evident
• Monitor triglycerides in parenterally fed patients at baseline and within 24 to 48 hours of starting nutrition support

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The landscape of treatment recommendations for COVID-19 will continue to change as more information is learned and more data is collected. These recommendations highlight what nutrition professionals working in the ICU know they can do today to best support COVID-19 patients in their recovery. We do know that nutrition plays a vital role in the recovery of critically ill patients. COVID-19 patients are no different in their need for appropriate, timely, and individualized nutrition support during their ICU stay.

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References:

Martindale R, Patel JJ, Taylor B, Warren M, McClave SA; ASPEN and SCCM. Nutrition therapy in the patient with COVID‐19 disease requiring ICU care. Updated April 1, 2020. https://www.nutritioncare.org/uploadedFiles/Documents/Guidelines_and_Clinical_Resources/Nutrition%20Therapy%20COVID-19_SCCM-ASPEN.pdf

Mulherin, D. W., Walker, R., Holcombe, B., Guenter, P., (2020). ASPEN Report on Nutrition Support Practice Processes with COVID-19: The First Response. Retrieved from: https://onlinelibrary.wiley.com/doi/full/10.1002/ncp.10553