Nutrition Support for Patients with COVID-19 Requiring Intensive Care Unit Treatment: A Rapid Review of Current Guidelines

Abstract

Abstract Background Coronavirus Disease 2019 (COVID-19) continues to ravage public health taking the lives of approximately 600,000 people and has been classified as a pandemic by the World Health Organization (WHO). The unexpected burden on the Intensive Care Unit (ICU) has become apparent, although at the time of writing, the proportion of patients requiring admission is estimated to be 5%. Nutrition support is considered an important factor in the management of critically ill COVID-19 patients, as prolonged ICU stay was observed among this population, itself, a major contributor to increased mortality. Objectives This review has evaluated available evidence-based nutrition support recommendations, aimed specifically at critically ill adults or elderly patients with COVID-19, through discussion of three aspects: nutrition requirement, Enteral Nutrition (EN) and Parenteral Nutrition (PN). Methodology This review was performed in accordance with the Cochrane Rapid Review guidelines, and a systematic search was carried out using PubMed, Ovid HMIC, Ovid MEDLINE, and the WHO COVID-19 databases. Inclusion criteria included worldwide guidelines published from December 2019 to present and targeted patients with COVID-19 in the ICU. The quality assessment was completed using the Appraisal of Guidelines for Research and Evaluation II tool (AGREE II). Result 10 guidelines were included in this review. It was suggested predictive equation be used to calculate patient requirements instead of indirect calorimetry. Hypocaloric nutrition supply (50%–70%) was preferred over isocaloric in the acute stage of the disease. Protein requirement was recommended as 1.2-2.0 gm/kg of body weight (BW), while the suggested carbohydrate level was limited (1.5 gm/kg of BW). Although continuous rather than bolus rout is favoured for enteral nutrition administration, bolus feeding is being frequently used in current emergency due to the shortage of EN pump. As enteral nutrition in prone position is being adopted for some patients with COVID-19, a number of considerations were highlighted. Parenteral nutrition is the last line of nutritional treatment however, lowering the switching thresholds for parenteral nutrition is important among patients with COVID19. Conclusion Optimising the nutrition support for COVID-19 patients in the ICU is an important matter that needs further investigation. High-quality guidelines are required.