Nutritional therapy in critically ill patients with COVID-19
A case review
Keywords:
CRITICAL CARE, CORONAVIRUS, CORONAVIRUS INFECTIONS, COVID-19, INTENSIVE CARE UNITS, NUTRITIONAL SUPPORT
Abstract
Introduction: acute respiratory distress syndrome and multiple organ dysfunction, which determine admission to the ICU, are a significant cause of morbimortality in patients with COVID-19. The patients with the worst clinical outcome, including a shorter survival in the ICU, are those with multiple comorbilities, different immunocompromised states, older adults and individuals with a history of malnutrition or suffering from malnutrition secondary to a critical illness. The nutritional impact of the critical illness on the striated appearance of skeletal muscle fibers may be exacerbated in some critically ill patients who are infected with SARS-CoV-2 and need to be admitted to the ICU.
Objective: this article aims to provide useful practical guidelines for clinicians based on updated clinical evidence and considering a few key characteristics that are specific to severe infection caused by SARS-Cov-2.
Method: we conducted a thorough review of the scientific literature published until April 2020 in English and Spanish.
Conclusions: the COVID-19 pandemic causes an unprecedented challenge in the ICU since up until today, no preventive measures have been proved successful to avoid evolution to critical illness and the therapies available for this stage of the disease are supported by quality clinical evidence. Within this complex framework we may trust that the measures that contribute to strengthening the immune system and ICU life-support therapies (including nutritional therapy) constitute essential tools to fight against severe infections caused by SARS-Cov-2. However, further studies are needed in the ICU scenario for specific recommendations to be made.
References
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(26) Vanhorebeek I, Verbruggen S, Casaer MP, Gunst J, Wouters PJ, Hanot J, et al. Effect of early supplemental parenteral nutrition in the paediatric ICU: a preplanned observational study of post-randomisation treatments in the PEPaNIC trial. Lancet Respir Med 2017; 5(6):475-83.
(27) de Koning MLY, Koekkoek WACK, Kars JCNH, van Zanten ARH. Association of PROtein and CAloric Intake and Clinical Outcomes in Adult SEPTic and Non-Septic ICU Patients on Prolonged Mechanical Ventilation: the PROCASEPT Retrospective Study. JPEN J Parenter Enteral Nutr 2019; 44(3):434-43.
(28) Koekkoek WAC, van Zanten ARH. Primum non nocere in early nutrition therapy during critical illness: balancing the pros and cons of early very high protein administration. Clin Nutr 2019; 38(4):1963-4.
(29) Schetz M, De Jong A, Deane AM, Druml W, Hemelaar P, Pelosi P, et al. Obesity in the critically ill: a narrative review. Intensive Care Med 2019; 45(6):757-69.
(30) Fraipont V, Preiser JC. Energy estimation and measurement in critically ill patients. JPEN J Parenter Enteral Nutr 2013; 37(6):705-13.
(31) Weijs PJ, Looijaard WG, Beishuizen A, Girbes AR, Oudemans-van Straaten HM. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Crit Care 2014; 18(6):701.
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(34) van Zanten ARH, Petit L, De Waele J, Kieft H, de Wilde J, van Horssen P, et al. Very high intact-protein formula successfully provides protein intake according to nutritional recommendations in overweight critically ill patients: a double-blind randomized trial. Crit Care 2018; 22(1):156.
(35) Bost RB, Tjan DH, van Zanten AR. Timing of (supplemental) parenteral nutrition in critically ill patients: a systematic review. Ann Intensive Care 2014; 4:31.
(36) Wei X, Day AG, Ouellette-Kuntz H, Heyland DK. The Association between nutritional adequacy and long-term outcomes in critically ill patients requiring prolonged mechanical ventilation: a multicenter cohort study. Crit Care Med 2015; 43(8):1569-79.
(37) Saez de la Fuente I, Saez de la Fuente J, Quintana Estelles MD, Garcia Gigorro R, Terceros Almanza LJ, Sanchez Izquierdo JA. Enteral nutrition in patients receiving mechanical ventilation in a prone position. JPEN J Parenter Enteral Nutr 2016; 40:250-5.
(38) Gombart AF, Pierre A, Maggini S. A review of micronutrients and the immune system-working in harmony to reduce the risk of infection. Nutrients 2020; 12(1):236. doi: 10.3390/ nu12010236.
(39) Levander OA, Beck MA. Selenium and viral virulence. Brit Med Bull 1999; 55:528-33.
(40) Guillin OM, Vindry C, Ohlmann T, Chavatte L. Selenium, selenoproteins and viral infection. Nutrients 2019; 11(9):2101. doi: 10.3390/nu11092101.
(41) Zhang L, Liu Y. Potential interventions for novel coronavirus in China: a systematic review. J Med Virol 2020; 92(5):479]90. doi: 10.1002/jmv.25707.
(42) van Zanten AR, Sztark F, Kaisers UX, Zielmann S, Felbinger TW, Sablotzki AR, et al. High-protein enteral nutrition enriched with immune-modulating nutrients vs standard high-protein enteral nutrition and nosocomial infections in the ICU: a randomized clinical trial. Jama 2014; 312:514-24.
(43) Heyland DK, Elke G, Cook D, Berger MM, Wischmeyer PE, Albert M, et al. Glutamine and antioxidants in the critically ill patient: a post hoc analysis of a large-scale randomized trial. JPEN J Parenter Enteral Nutr 2015; 39:401-9.
(44) Lu C, Sharma S, McIntyre L, Rhodes A, Evans L, Almenawer S, et al. Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials. Ann Intensive Care 2017; 7:58.
(45) Blaauw R, Osland E, Sriram K, Allard JP, Ball P, Chan LN, et al. Parenteral provision of micronutrients to adult patients: an expert consensus paper. JPEN J Parenter Enteral Nutr 2019; 43 (Suppl 1):S5]S23. doi: 10.1002/jpen.1525.
(46) Manzanares W, Lemieux M, Elke G, Langlois PL, Bloos F, Heyland DK. High-dose intravenous selenium does not improve clinical outcomes in the critically ill: a systematic review and meta-analysis. Crit Care 2016; 20:356.
(47) Zhang M, Jativa DF. Vitamin C supplementation in the critically ill: a systematic review and meta-analysis. SAGE Open Med 2018; 6:205031211880761.
(48) Fowler AA, Truwit JD, Hite RD, Morris PE, DeWilde C, Priday A, et al. Effect of vitamin c infusion on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure: the CITRIS-ALI randomized clinical trial. JAMA 2019; 322:1261-70.
(49) Langlois PL, Szwec C, D’Aragon F, Heyland DK, Manzanares W. Vitamin D supplementation in the critically ill: a systematic review and meta-analysis. Clin Nutr 2018; 37(4):1238]46. doi: 10.1016/j.clnu.2017.05.006.
(2) Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China JAMA. 2020; 323(11):1061]9. doi: 10.1001/jama.2020. 1585.
(3) Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. Covid-19 in critically ill patients in the Seattle Region - Case Series. N Engl J Med 2020; 382(21):2012]22. doi: 10.1056/NEJMoa2004500.
(4) Bouadma L, Lescure FX, Lucet JC, Yazdanpanah Y, Timsit JF. Severe SARS-CoV-2 infections: practical considerations and management strategy for intensivists. Intensive Care Med 2020; 46(4):579-82. doi: 10.1007/s00134- 020-05967-x.
(5) Peng YD, Meng K, Guan HQ, Leng L, Zhu RR, Wang BY. Clinical characteristics and outcomes of 112 cardiovascular disease patients infected by 2019-nCoV. Zhonghua Xin Xue Guan Bing Za Zhi 2020; 48(6):450-5.
(6) Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S. Risk factors associated with acute respiratory distress syndrome and death in patients with Coronavirus Disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020; 180(7):934-43.
(7) Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 2019; 38:48-79.
(8) Martindale R, Patel JJ, Taylor B, Warren M, McClave SA; American Society for Parenteral and Enteral Nutrition; Society of Critical Care Medicine. Nutrition therapy in the patient with COVID-19 disease requiring ICU Care (Updated April 1, 2020). 2020:8p.
(9) McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al; Society of Critical Care Medicine; American Society for Parenteral and Enteral Nutrition. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 2016; 40(2):159-211.
(10) Merchan C, Altshuler D, Aberle C, Papadopoulos J, Schwartz D. Tolerability of enteral nutrition in mechanically ventilated patients with septic shock who require vasopressors. J Intensive Care Med 2017; 32(9):540-6. doi: 10.1177/0885066616656799.
(11) Ohbe H, Jo T, Matsui H, Fushimi K, Yasunaga H. Differences in effect of early enteral nutrition on mortality among ventilated adults with shock requiring low-, medium-, and high-dose noradrenaline: a propensity-matched analysis. Clin Nutr 2020; 39(2):460]7. doi: 10.1016/j.clnu.2019.02.020.
(12) Rokyta R Jr, Matejovik M, Krouzecký A, Novak I. Enteral nutrition and hepatosplanchnic region in critically ill patients - friends or foes? Physiol Res 2003; 52(1):31-7.
(13) Reignier J, Boisramé-Helms J, Brisard L, Lascarrou JB, Ait Hssain A, Anguel N, et al; NUTRIREA-2 Trial Investigators; Clinical Research in Intensive Care and Sepsis (CRICS) group. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet 2018; 391(10116):133-43.
(14) Piton G, Le Gouge A, Brulé N, Cypriani B, Lacherade JC, Nseir S, et al. Impact of the route of nutrition on gut mucosa in ventilated adults with shock: an ancillary of the NUTRIREA-2 trial. Intensive Care Med 2019; 45(7):948-56.
(15) Patel JJ, Rice T, Heyland DK. Safety and outcomes of early enteral nutrition in circulatory shock. JPEN J Parenter Enteral Nutr 2020; 44(5):779-84. doi: 10.1002/jpen.1793.
(16) Terzi N, Darmon M, Reignier J, Ruckly S, Garrouste-Orgeas M, Lautrette A, et al; OUTCOMEREA study group. Initial nutritional management during non invasive ventilation and outcomes: a retrospective cohort study. Crit Care 2017; 21:293. doi: 10.1186/s13054-017-1867-y.
(17) Reeves A, White H, Sosnowski K, Tran K, Jones M, Palmer M. Energy and protein intakes of hospitalized patients with acute respiratory failure receiving non-invasive ventilation. Clin Nutr 2014; 33:1068-73.
(18) Singer P, Rattanachaiwong S. To eat or to breathe? The answer is both! Nutritional management during noninvasive ventilation. Crit Care 2018; 22(1):27. doi: 10.1186/ s13054-018-1947-7.
(19) Kogo M, Nagata K, Morimoto T, Ito J, Sato Y, Teraoka S, et al. Enteral nutrition is a risk factor for airway complications in subjects undergoing noninvasive ventilation for acute respiratory failure. Respir Care 2017; 62: 459-67.
(20) Reintam Blaser A, Starkopf J, Alhazzani W, Berger MM, Casaer MP, Deane AM, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med 2017; 43:380-98.
(21) Lew CCH, Yandell R, Fraser RJL, Chua AP, Chong FF, Miller M. Association between malnutrition and clinical outcomes in the intensive care unit: a systemic review. JPEN J Parenter Enteral Nutr 2017; 41(5):744-58.
(22) Bendavid I, Singer P, Theilla M, Themessl-Huber M, Sulz I, Mouhieddine M, et al. NutritionDay ICU: a 7 year worldwide prevalence study of nutrition practice in intensive care. Clin Nutr 2017; 36:1122-9.
(23) Leder SB, Siner JM, Bizzaro MJ, McGinley BM, Lefton-Greif MA. Oral alimentation in neonatal and adult populations requiring high-flow oxygen via nasal cannula. Dysphagia 2016; 31:154-9.
(24) Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P, et al. Acute skeletal muscle wasting in critical illness. JAMA 2013; 310(15):1591-600.
(25) Compher C, Chittams J, Sammarco T, Nicolo M, Heyland DK. Greater protein and energy intake may be associated with improved mortality in higher risk critically ill patients: a multicenter, multinational observational study. Crit Care Med 2017; 45:156-63.
(26) Vanhorebeek I, Verbruggen S, Casaer MP, Gunst J, Wouters PJ, Hanot J, et al. Effect of early supplemental parenteral nutrition in the paediatric ICU: a preplanned observational study of post-randomisation treatments in the PEPaNIC trial. Lancet Respir Med 2017; 5(6):475-83.
(27) de Koning MLY, Koekkoek WACK, Kars JCNH, van Zanten ARH. Association of PROtein and CAloric Intake and Clinical Outcomes in Adult SEPTic and Non-Septic ICU Patients on Prolonged Mechanical Ventilation: the PROCASEPT Retrospective Study. JPEN J Parenter Enteral Nutr 2019; 44(3):434-43.
(28) Koekkoek WAC, van Zanten ARH. Primum non nocere in early nutrition therapy during critical illness: balancing the pros and cons of early very high protein administration. Clin Nutr 2019; 38(4):1963-4.
(29) Schetz M, De Jong A, Deane AM, Druml W, Hemelaar P, Pelosi P, et al. Obesity in the critically ill: a narrative review. Intensive Care Med 2019; 45(6):757-69.
(30) Fraipont V, Preiser JC. Energy estimation and measurement in critically ill patients. JPEN J Parenter Enteral Nutr 2013; 37(6):705-13.
(31) Weijs PJ, Looijaard WG, Beishuizen A, Girbes AR, Oudemans-van Straaten HM. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Crit Care 2014; 18(6):701.
(32) Arabi YM, Aldawood AS, Haddad SH, Al-Dorzi HM, Tamim HM, Jones G, et al. PermiT Trial Group Permissive underfeeding or standard enteral feeding in critically ill adults. N Engl J Med 2015; 372(25):2398-2408.
(33) Chapman M, Peake SL, Bellomo R, Davies A, Deane A, Horowitz M, et al. TARGET Investigators, for the ANZICS Clinical Trials Group. Energy-dense versus routine enteral nutrition in the critically ill. N Engl J Med 2018; 379(19): 1823-34.
(34) van Zanten ARH, Petit L, De Waele J, Kieft H, de Wilde J, van Horssen P, et al. Very high intact-protein formula successfully provides protein intake according to nutritional recommendations in overweight critically ill patients: a double-blind randomized trial. Crit Care 2018; 22(1):156.
(35) Bost RB, Tjan DH, van Zanten AR. Timing of (supplemental) parenteral nutrition in critically ill patients: a systematic review. Ann Intensive Care 2014; 4:31.
(36) Wei X, Day AG, Ouellette-Kuntz H, Heyland DK. The Association between nutritional adequacy and long-term outcomes in critically ill patients requiring prolonged mechanical ventilation: a multicenter cohort study. Crit Care Med 2015; 43(8):1569-79.
(37) Saez de la Fuente I, Saez de la Fuente J, Quintana Estelles MD, Garcia Gigorro R, Terceros Almanza LJ, Sanchez Izquierdo JA. Enteral nutrition in patients receiving mechanical ventilation in a prone position. JPEN J Parenter Enteral Nutr 2016; 40:250-5.
(38) Gombart AF, Pierre A, Maggini S. A review of micronutrients and the immune system-working in harmony to reduce the risk of infection. Nutrients 2020; 12(1):236. doi: 10.3390/ nu12010236.
(39) Levander OA, Beck MA. Selenium and viral virulence. Brit Med Bull 1999; 55:528-33.
(40) Guillin OM, Vindry C, Ohlmann T, Chavatte L. Selenium, selenoproteins and viral infection. Nutrients 2019; 11(9):2101. doi: 10.3390/nu11092101.
(41) Zhang L, Liu Y. Potential interventions for novel coronavirus in China: a systematic review. J Med Virol 2020; 92(5):479]90. doi: 10.1002/jmv.25707.
(42) van Zanten AR, Sztark F, Kaisers UX, Zielmann S, Felbinger TW, Sablotzki AR, et al. High-protein enteral nutrition enriched with immune-modulating nutrients vs standard high-protein enteral nutrition and nosocomial infections in the ICU: a randomized clinical trial. Jama 2014; 312:514-24.
(43) Heyland DK, Elke G, Cook D, Berger MM, Wischmeyer PE, Albert M, et al. Glutamine and antioxidants in the critically ill patient: a post hoc analysis of a large-scale randomized trial. JPEN J Parenter Enteral Nutr 2015; 39:401-9.
(44) Lu C, Sharma S, McIntyre L, Rhodes A, Evans L, Almenawer S, et al. Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials. Ann Intensive Care 2017; 7:58.
(45) Blaauw R, Osland E, Sriram K, Allard JP, Ball P, Chan LN, et al. Parenteral provision of micronutrients to adult patients: an expert consensus paper. JPEN J Parenter Enteral Nutr 2019; 43 (Suppl 1):S5]S23. doi: 10.1002/jpen.1525.
(46) Manzanares W, Lemieux M, Elke G, Langlois PL, Bloos F, Heyland DK. High-dose intravenous selenium does not improve clinical outcomes in the critically ill: a systematic review and meta-analysis. Crit Care 2016; 20:356.
(47) Zhang M, Jativa DF. Vitamin C supplementation in the critically ill: a systematic review and meta-analysis. SAGE Open Med 2018; 6:205031211880761.
(48) Fowler AA, Truwit JD, Hite RD, Morris PE, DeWilde C, Priday A, et al. Effect of vitamin c infusion on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure: the CITRIS-ALI randomized clinical trial. JAMA 2019; 322:1261-70.
(49) Langlois PL, Szwec C, D’Aragon F, Heyland DK, Manzanares W. Vitamin D supplementation in the critically ill: a systematic review and meta-analysis. Clin Nutr 2018; 37(4):1238]46. doi: 10.1016/j.clnu.2017.05.006.
Published
2020-12-01
How to Cite
1.
Moreira E, Olano E, Manzanares W. Nutritional therapy in critically ill patients with COVID-19. Rev. Méd. Urug. [Internet]. 2020Dec.1 [cited 2024Dec.28];36(4):382-9. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/644
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