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Review
. 2021 Aug:44:69-77.
doi: 10.1016/j.clnesp.2021.05.003. Epub 2021 May 25.

Nutrition guidelines for critically ill adults admitted with COVID-19: Is there consensus?

Lee-Anne S Chapple  1 , Oana A Tatucu-Babet  2 , Kate J Lambell  3 , Kate Fetterplace  4 , Emma J Ridley  3
Affiliations
Review

Nutrition guidelines for critically ill adults admitted with COVID-19: Is there consensus?

Lee-Anne S Chapple et al. Clin Nutr ESPEN. 2021 Aug.

Abstract

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic has overwhelmed hospital systems globally, resulting in less experienced staff caring for critically ill patients within the intensive care unit (ICU). Many guidelines have been developed to guide nutrition care.

Aim: To identify key guidelines or practice recommendations for nutrition support practices in critically ill adults admitted with COVID-19, to describe similarities and differences between recommendations, and to discuss implications for clinical practice.

Methods: A literature review was conducted to identify guidelines affiliated with or endorsed by international nutrition societies or dietetic associations which included recommendations for the nutritional management of critically ill adult patients with COVID-19. Data were extracted on pre-defined key aspects of nutritional care including nutrition prescription, delivery, monitoring and workforce recommendations, and key similarities and discrepancies, as well as implications for clinical practice were summarized.

Results: Ten clinical practice guidelines were identified. Similar recommendations included: the use of high protein, volume restricted enteral formula delivered gastrically and commenced early in ICU and introduced gradually, while taking into consideration non-nutritional calories to avoid overfeeding. Specific advice for patients in the prone position was common, and non-intubated patients were highlighted as a population at high nutritional risk. Major discrepancies included the use of indirect calorimetry to guide energy targets and advice around using gastric residual volumes (GRVs) to monitor feeding tolerance.

Conclusion: Overall, common recommendations around formula type and route of feeding exist, with major discrepancies being around the use of indirect calorimetry and GRVs, which reflect international ICU nutrition guidelines.

Keywords: COVID-19; Dietitian; Enteral nutrition; Guideline; Nutrition support; Recommendations.

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Conflict of interest statement

Declaration of competing interest There are no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
CONSORT diagram of included guidelines. ANSISA: National Association of Specialists in Food Science (Italy); ASPEN: American Society for Parenteral and Enteral Nutrition; AuSPEN: Australasian Society for Parenteral and Enteral Nutrition; BDA: British Dietetic Association; BRASPEN: Brazilian Society of Parenteral and Enteral Nutrition; ESPEN: European Society for Clinical Nutrition and Metabolism; INDI: Irish Nutrition and Dietetic Institute; IDA: Indian Dietetic Association; ATID: Israeli Dietetic Association; TDA: Turkish Dietetic Association.
Fig. 2
Fig. 2
Geographical location of guideline development. ASPEN: American Society for Parenteral and Enteral Nutrition; AuSPEN: Australasian Society for Parenteral and Enteral Nutrition; BRASPEN: Brazilian Society of Parenteral and Enteral Nutrition; BDA: British Dietetic Association; ESPEN: European Society for Clinical Nutrition and Metabolism; IDA: Indian Dietetic Association; INDI: Irish Nutrition and Dietetic Institute; ATID: Israeli Dietetic Association; ANSISA: National Association of Specialists in Food Science (Italy); TDA: Turkish Dietetic Association.
See this image and copyright information in PMC

References

    1. Minnelli N., Gibbs L., Larrivee J., Sahu K.K. Challenges of maintaining optimal nutrition status in COVID-19 patients in intensive care settings. J Parenter Enter Nutr. 2020;44(8):1439–1446. - PMC - PubMed
    1. Grasselli G., Pesenti A., Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. J Am Med Assoc. 2020;323(16):1545–1546. - PubMed
    1. Fernandez-Quintela A., Milton-Laskibar I., Trepiana J., Gomez-Zorita S., Kajarabille N., Leniz A., et al. Key aspects in nutritional management of COVID-19 patients. J Clin Med. 2020;9(8) - PMC - PubMed
    1. Chapple L., Fetterplace K., Ridley E. Nutrition for critically ill patients with COVID-19: ICU management and practice. ICU Management & Practice. 2020;20(1):52–57.
    1. Richards-Belle A., Orzechowska I., Gould D.W., Thomas K., Doidge J.C., Mouncey P.R., et al. COVID-19 in critical care: epidemiology of the first epidemic wave across England, Wales and Northern Ireland. Intensive Care Med. 2020;46(11):2035–2047. - PMC - PubMed