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. 2022 Dec;41(12):3069-3076.
doi: 10.1016/j.clnu.2021.03.033. Epub 2021 Mar 29.

Feeding intolerance in critically ill patients with COVID-19

Rebecca Liu  1 , Mary Paz  2 , Layla Siraj  3 , Taylor Boyd  4 , Silvia Salamone  4 , Thúy-Lan Võ Lite  4 , Krystle M Leung  1 , Josue D Chirinos  4 , Helen H Shang  4 , Matthew J Townsend  4 , Junsung Rho  5 , Peiyun Ni  1 , Kushi Ranganath  4 , April D Violante  6 , Zezhou Zhao  3 , Casey Silvernale  2 , Imama Ahmad  7 , Nira A Krasnow  4 , Erica S Barnett  4 , Mukesh Harisinghani  5 , Braden Kuo  2 , Katharine E Black  8 , Kyle Staller  9
Affiliations

Feeding intolerance in critically ill patients with COVID-19

Rebecca Liu et al. Clin Nutr. 2022 Dec.

Abstract

Background & aims: Early reports suggest significant difficulty with enteral feeding in critically ill COVID-19 patients. This study aimed to characterize the prevalence, clinical manifestations, and outcomes of feeding intolerance in critically ill patients with COVID-19.

Methods: We examined 323 adult patients with COVID-19 admitted to the intensive care units (ICUs) of Massachusetts General Hospital between March 11 and June 28, 2020 who received enteral nutrition. Systematic chart review determined prevalence, clinical characteristics, and hospital outcomes (ICU complications, length of stay, and mortality) of feeding intolerance.

Results: Feeding intolerance developed in 56% of the patients and most commonly manifested as large gastric residual volumes (83.9%), abdominal distension (67.2%), and vomiting (63.9%). Length of intubation (OR 1.05, 95% CI 1.03-1.08), ≥1 GI symptom on presentation (OR 0.76, 95% CI 0.59-0.97), and severe obesity (OR 0.29, 95% CI 0.13-0.66) were independently associated with development of feeding intolerance. Compared to feed-tolerant patients, patients with incident feeding intolerance were significantly more likely to suffer cardiac, renal, hepatic, and hematologic complications during their hospitalization. Feeding intolerance was similarly associated with poor outcomes including longer ICU stay (median [IQR] 21.5 [14-30] vs. 15 [9-22] days, P < 0.001), overall hospitalization time (median [IQR] 30.5 [19-42] vs. 24 [15-35], P < 0.001) and in-hospital mortality (33.9% vs. 16.1%, P < 0.001). Feeding intolerance was independently associated with an increased risk of death (HR 3.32; 95% CI 1.97-5.6).

Conclusions: Feeding intolerance is a frequently encountered complication in critically ill COVID-19 patients in a large tertiary care experience and is associated with poor outcomes.

Keywords: Feeding intolerance; GI dysmotility; ICU; Malnutrition; SARS-CoV-2.

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Conflict of interest statement

Conflict of interest KS has received research support from AstraZeneca, Takeda, and Gelesis, has served as a speaker for Shire, and has served as a consultant to Gelesis, Synergy, and Shire.

Figures

Fig. 1
Fig. 1
Predictors of feeding intolerance in critically ill patients with COVID-19. Odds ratios with 95% confidence intervals of risk factors for developing feeding intolerance in critically ill patients with COVID-19. Risk factors shown were chosen using both clinical and univariate predictor analysis. SOFA, Sequential Organ Failure Assessment; GI, gastrointestinal; BMI, body mass index, with categories defined as: severe obesity with a BMI of ≥40 kg/m2, obesity 30–39.9 kg/m2, overweight 25–29.9 kg/m2, normal 18.5–24.9 kg/m2, and underweight <18.5 kg/m2; Racial categories are expressed relative to white race; OR (95% CI), odds ratio and 95% confidence interval.
Fig. 2
Fig. 2
Survival of critically ill COVID-19 patients by presence of feeding intolerance.
See this image and copyright information in PMC

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