Nutrition in the Critically Ill with COVID-19

We can always count on the ASPEN team to come through for us regarding nutritional recommendations for our patients with COVID-19. A hat tip to them. A hat tip also to my pharmacist teammate, Amanda, for sending this to me (and many other literature goodies). This is free so download your own copy and don't trust me.

Let's take a look. First of all, to make one thing clear, there's no RCT on how to provide nutrition particularly to COVID patients. These recommendations need to be extrapolated from other data. This document was updated today. I enjoyed how they took into account preserving PPE in their recs.

The recs:

- start EN within 24-36 hours of admission to the ICU or within 12h of intubation.

- start with trickle/trophic feeds and ramp it up as stated in the document.

- use weight based equations for the correct amount of nutrition

- trophic feeds if patients are on vasopressors (not if increasing VP doses, though). My understanding is that most of these patients are hemodynamically stable. If the patient is getting sicker, do not feed.

- no recommendations regarding patients on paralytics.

- start with gastric feeds, if this fails, try prokinetics, if this fails, feed post-pyloric. I know there are logistical issues with this at different institutions. They also recommend against post-pyloric feeding tubes needing fluoro for placement due to limiting exposure to HCW.

- continuous feeds recommended over bolus feeds (less PPE)

- they make recommendations about TPN that I won't mention here

- they recommend checking triglyceride levels in patients on propofol within the first 24 hours due to a subset of patients who develop secondary HLH. Not going down this road right now.

- they do not recommend checking gastric residuals. This is something I've covered in the past and it will save PPE.

- feeding proned patients: you could feed the gastric chamber. This is something that I have been asked.

It's only an 8 page document. Check it out for yourself!

-EJ

Link to Abstract

Link to FULL FREE PDF

Nutrition and Gut Health in the ICU: Citations

References to the Enteral Nutrition Lecture

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