Gastrointestinal (GI) symptoms did not interfere with enteral nutrition delivery, since more than 80% of patients critically ill with COVID-19 met nutritional intake goals, according to study findings published in Clinical Nutrition.

Researchers performed an observational study to evaluate the relationship between enteral nutrition and GI symptoms in 150 patients critically ill with COVID-19. For the first 14 days, patients were treated in an ICU at Erasmus Medical Center in the Netherlands between April 2020 and November 2020.

The researchers calculated total delivered nutritional intake, adding all sources of protein, non-nutritional and nutritional calories, and energy sources administered during the first 14 days in the ICU. Individualized nutritional goals were set for each patient on the day of admission and re-evaluated on days 4, 10, and 14.


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The investigators collected data regarding GI symptoms, including diarrhea, abdominal distension, vomiting, gastric residual volume (GRV), and acute gastrointestinal injury (AGI) with grades ranging from 1 (mild) to 4 (severe), also on days 0, 4, 10, and 14.

Initially, nasogastric tubes provided continuous enteral nutrition of high-protein polymeric formulas supplemented with enteral liquid protein modules as indicated. In patients who demonstrated high GRV, nasoduodenal tubes bypassed the stomach to provide enteral nutrition. In patients with enteral nutrition intolerance, parenteral nutrition provided nutrients.

Of the 150 patients, 38 (25%) died during ICU admission. Patients stayed a median length of 19 (IQR, 12-32) days in the ICU, with most patients receiving ventilation for a median of 18 (IQR, 10-30) days.

During the first 4 days, 98% of the patients required enteral nutrition, while 96% still required enteral nutrition between days 10 and 14. Most required nasogastric tube feeds (74%) during the first 4 days. Patients required increasing supplementation using enteral liquid protein modules — 35% at day 4, 55% at day 10, and 60% at day 14.

Attainment of protein goals improved from 84% at day 4 to 93% on days 10 to 14. Around 80% of the critically ill patients met their individualized energy (66% on day 4, 83% on days 10-14) and protein goals (55% on day 4, 80% on days 10-14) by the end of their ICU admission.

Moderate GI symptoms decreased, while mild GI symptoms increased during ICU admission. No patients developed GI failure (AGI grade 4).

Moderate GI symptoms on admission correlated with increased energy intake (P =.020). Diarrhea correlated with higher energy (P =.039) and protein (P <.001) intakes. Patients with AGI grade 3 demonstrated lower protein intake at day 10 (P =.020), suggesting the need to consider administration of supplemental enteral liquid protein modules in these patients.

“Based on our results, GI dysfunction seems no major issue in critically ill COVID-19 patients,” the study authors concluded.

Although GI symptoms occurred at a low frequency and did not prevent enteral nutrition administration in patients who were critically ill with COVID-19, “nutritional intake was just below nutritional goals during ICU admission,” the study authors noted. “It is recommended to monitor adequate protein intake in patients with more GI symptoms (AGI 3).”

Study limitations included potential underreporting of symptoms in medical charts and the short scope of the study duration, covering only the first 14 days of ICU admission.

Reference

Lakenman PLM, van Schie JC, van der Hoven B, et al. Nutritional intake and gastro-intestinal symptoms in critically ill COVID-19 patients. Clin Nutr. Published online April 6, 2022. doi:10.1016/j.clnu.2022.04.001

This article originally appeared on Gastroenterology Advisor