Nutrition evaluation and management of critically ill patients with COVID-19 during post-intensive care rehabilitation

Abstract

Background: Among hospitalized patients with coronavirus disease 2019 (COVID-19), up to 12% may require intensive care unit (ICU) management. The aim of this prospective cohort study is to assess nutrition status and outcome in patients with COVID-19 following ICU discharge.

Methods: Patients requiring a minimum of 14 days' stay in the ICU with mechanical ventilation were included. Nutrition status was assessed at inclusion (ICU discharge) and follow-up (after 15, 30, and 60 days). All patients had standardized medical nutrition therapy with defined targets regarding energy (30 kcal/kg/d) and protein intake (1.5 g/kg/d).

Results: Fifteen patients were included (67% males); the median age was 60 (33-75) years old. Body mass index at ICU admission was 25.7 (IQR, 24-31) kg/m². After a median ICU stay of 33 (IQR, 26-39) days, malnutrition was present in all patients (11.3% median weight loss and/or low muscle mass based on handgrip strength measurement). Because of postintubation dysphagia in 60% of patients, enteral nutrition was administered (57% nasogastric tube; 43% percutaneous endoscopic gastrostomy). After 2 months, a significant improvement in muscle strength was observed (median handgrip strength, 64.7% [IQR, 51%-73%] of the predicted values for age vs 19% [IQR, 4.8%-28.4%] at ICU discharge [P < 0.0005]), as well as weight gain of 4.3 kg (IQR, 2.7-6.7 kg) (P < 0.0002).

Conclusions: Critically ill patients with COVID-19 requiring ICU admission and mechanical ventilation have malnutrition and low muscle mass at ICU discharge. Nutrition parameters improve during rehabilitation with standardized medical nutrition therapy.

Keywords: SARS-CoV2; malnutrition; medical nutrition therapy; nutrition support.

Figure 1

Flow‐chart illustrating enrolment of coronavirus disease 2019 patients discharged from the intensive care unit (ICU)

Figure 2

Nutrition intake in intensive care unit (ICU) during the phases of critical illness. Representative median of energy intake according to the kilocalories per kilos per day (kcal/kg/d) (the weight measured upon admission to the ICU) followed until discharge from ICU. Each median of kcal/kg/d is calculated each day with the number of patients remaining in ICU. Each median was the energy data of 13 patients. Two patients were transferred from another hospital and their nutrition data were missing

Figure 3

Nutrition support for individual patients and nutrition intake (energy and protein) during the 2 months of follow‐up. (A) Representative nutrition support of the 15 patients and their duration (in days). Each support is represented with a different shade of gray. One patient was lost to follow‐up at day 30. (B) Each plot represented the median of kcal/kg/d and g/kg/d protein at the time to the follow‐up. D, day; ICU, intensive care unit; no., number

Figure 4

(A) Correlation between body mass index (BMI) and mid‐arm circumference. (B) Individual dominant handgrip strength at the time of intensive care unit discharge and at day (D) 7, 14, 30, and 60 for 13 patients. Each patient is represented with a shade of gray