Health through nutrition & lifestyle

Many patients who fall into the at-risk group (incl. older people) and have been advised to follow stay at home, are also those considered to be at greater risk of malnutrition. Malnutrition is a serious condition which can increase a person’s risk of infection as well as slowing down their recovery:

For more information see also the following websites:

BDA (The Association of UK Dieticians): COVID-19 / Coronavirus - Advice for the General Public

BDA (The Association of UK Dieticians): Malnutrition: Food Fact Sheet

Yes, it is well recognised that mechanically ventilated patients have severe catabolic muscle wasting (approximately 30% in 20 days) and poor long term outcomes (Herridge). It is also well recognised that patients being mechanically ventilated for longer period, on removal of ventilatory support struggle to increase their oral intake (Peterson 2010) and often need ongoing intensive nutrition support to meet their elevated requirements during recovery (Lambeth 2020, Ridley 2019).

For more information see also the following websites:

Publication: Functional disability 5 years after acute respiratory distress syndrome

Publication: Nutrition therapy in critical illness: a review of the literature for clinicians

Publication: What Happens to Nutrition Intake in the Post-Intensive Care Unit Hospitalization Period? An Observational Cohort Study in Critically Ill Adults

Recently, nutrition recommendation guidelines have been published for the dietary management of COVID-19 patients.

For more information see also the following websites:

Publication: Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19) ESICM (European Society of Intensive Care Medicine) Blog: Acute Kidney Injury in COVID-19 Patients

BDA (The Association of UK Dieticians) - Critical Care Specialist Group (CCSG) of the BDA Guidance on management of nutrition and dietetic services during the COVID-19 pandemic

Publication: ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection

Publication: Nutrition Therapy in the Patient with COVID-19 Disease Requiring ICU Care

INDI (Irish Nutrition Dietetic Institute: Online Nutrition Resources for Covid19

General recommendations for critically ill patients, The majority of the guidelines from medical societies are recommending early commencement and buildup of enteral nutrition and that this is best practice for critically ill and acute respiratory distress syndrome (ARDS) patients. There are some concerns about early supplementary parenteral nutrition (PN) commencement and the use of supplementary PN with extracorporeal membrane oxygenation (ECMO) patients. However if nasogastric (NG) feeding causes persistent intolerance, and nasojejunal (NJ) feeding is not possible, it may be preferable to ensure these patients are fed with more specialised/hydrolysed feeds or PN.

For more information see also the following websites:

SCCM (Society of Critical Care Medicine): COVID-19 Guidelines

ESPEN: Coronavirus, A word from ESPEN

Nutritional and Critical Care Societies do not give specific nutritional recommendations for COVID-19 patients. Therefore general recommendations for critically ill patients

• Energy requirement: the internationally widely used recommendation of 25-30 kcal per kg body weight of energy is recommended.
• Protein requirement: 1.2-2.0 g / kg of protein is recommended.
  It is also generally recommended to administer enteral nutrition slowly to a uniform speed. For patients staying in ICU long term (>3 days) it is important to monitor nutritional status and if possible and required based on patients’ needs support with (enteral) nutrition. 

For more information see also the following website: 

Researchgate: Handbook of COVID-19 Prevention and Treatment