Abstract
Background: In this study, a report of dietitian-led nutrition interventions for patients with COVID-19 during ICU and ward-based rehabilitation is provided. As knowledge of COVID-19 and its medical treatments evolved through the course of the pandemic, dietetic-led interventions were compared between surge 1 (S1) and surge 2 (S2). Methods: A prospective observational study was conducted of patients admitted to the ICU service in a large academic hospital (London, UK). Clinical and nutrition data were collected during the first surge (March–June 2020; n = 200) and the second surge (November 2020–March 2021; n = 253) of COVID-19. Results: A total of 453 patients were recruited. All required individualized dietetic-led interventions during ICU admission as the ICU nutrition protocol did not meet nutritional needs. Feed adjustments for deranged renal function (p = 0.001) and propofol calories (p = 0.001) were more common in S1, whereas adjustment for gastrointestinal dysfunction was more common in S2 (p = 0.001). One-third of all patients were malnourished on ICU admission, and all lost weight in ICU, with a mean (SD) total percentage loss of 8.8% (6.9%). Further weight loss was prevented over the remaining hospital stay with continued dietetic-led interventions. Conclusions: COVID-19 patients have complex nutritional needs due to malnutrition on admission and ongoing weight loss. Disease complexity and evolving nature of medical management required multifaceted dietetic-led nutritional strategies, which differed between surges.
Highlights
In March 2020, the exponential increase in intensive care unit (ICU) admissions in the United Kingdom (UK) due to the COVID-19 pandemic required significant planning and restructuring of dietetic services to ensure safe and effective nutrition provision [1]
Length of ICU stay was longer in surge 2 (S2) (p = 0.019) (Table 1)
Over one-third of patients were malnourished on ICU admission, and patients lost an average of 7.9 kg over the ICU stay
Summary
In March 2020, the exponential increase in intensive care unit (ICU) admissions in the United Kingdom (UK) due to the COVID-19 pandemic required significant planning and restructuring of dietetic services to ensure safe and effective nutrition provision [1]. ICU dietitians were faced with multiple challenges including how best to provide nutrition support for patients with an unknown disease, rapidly train redeployed dietitians inexperienced in ICU nutrition, prioritize dietetic-led nutrition interventions, and manage the logistics of shortages of enteral feed, feed pumps, and ancillaries. COVID-19 patients frequently present with malnutrition [2,3] This is due to preexisting chronic disease associated with underlying poor nutritional intake, combined with a further decline due to common COVID-19 symptoms including gastrointestinal dysfunction and loss of taste and smell [2]. A report of dietitian-led nutrition interventions for patients with COVID-19 during ICU and ward-based rehabilitation is provided. Conclusions: COVID-19 patients have complex nutritional needs due to malnutrition on admission and ongoing weight loss. Disease complexity and evolving nature of medical management required multifaceted dietetic-led nutritional strategies, which differed between surges
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