Nutrition therapy in the intensive care unit during the COVID-19 pandemic: Findings from the ISIIC point prevalence study

Kensuke Nakamura; Keibun Liu; Hajime Katsukawa; Peter Nydahl; Eugene Wesley Ely; Sapna R Kudchadkar; Shigeaki Inoue; Alan Kawarai Lefor; Osamu Nishida

doi:10.1016/j.clnu.2021.09.033

Nutrition therapy in the intensive care unit during the COVID-19 pandemic: Findings from the ISIIC point prevalence study

Clin Nutr. 2022 Dec;41(12):2947-2954. doi: 10.1016/j.clnu.2021.09.033. Epub 2021 Sep 27.

Authors

Kensuke Nakamura¹, Keibun Liu², Hajime Katsukawa³, Peter Nydahl⁴, Eugene Wesley Ely⁵, Sapna R Kudchadkar⁶, Shigeaki Inoue⁷, Alan Kawarai Lefor⁸, Osamu Nishida⁹

Affiliations

¹ Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki, Japan.
² Critical Care Research Group, Faculty of Medicine, University of Queensland and the Prince Charles Hospital, Brisbane, Australia. Electronic address: keiliu0406@gmail.com.
³ Japanese Society for Early Mobilization, Tokyo, Japan.
⁴ Nursing Research, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Kiel, Germany.
⁵ Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University School of Medicine, Nashville, TN, USA; Geriatric Research Education and Clinical Center (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA.
⁶ Department of Anesthesiology and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁷ Emergency and Critical Care Center, Kobe University Hospital, Kobe, Japan; Department of Disaster and Emergency Medicine, Kobe University, Graduate School of Medicine, Kobe, Japan.
⁸ Department of Surgery, Jichi Medical University, Tochigi, Japan.
⁹ Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan.

Abstract

Background & aims: Nutrition therapy for Intensive Care Unit (ICU) patients involves complex decision-making, especially during the COVID-19 pandemic. We investigated the use of nutrition therapy in ICU patients with and without COVID-19 infections.

Methods: Nutrition therapy was evaluated during a world-wide one-day prevalence study focused on implementation of the ABCDEF bundle (A: regular pain assessment, B: both spontaneous awakening and breathing trials, C: regular sedation assessment, D: regular delirium assessment, E: early mobility and exercise, and F: family engagement and empowerment) during the COVID-19 pandemic. Basic ICU and patient demographics including nutrition therapy delivery were collected on the survey day. Physical activity for patients with and without COVID infections was categorized using the ICU mobility scale (IMS). Multivariable regression analysis of nutrition was conducted using ICU parameters.

Results: The survey included 627 non-COVID and 602 COVID patients. A higher proportion of COVID-19 patients received energy ≥20 kcal/kg/day (55% vs. 45%; p = 0.0007) and protein ≥1.2 g/kg/day (45% vs. 35%; p = 0.0011) compared to non-COVID patients. Enteral nutrition was provided to most COVID patients even with prone positioning (91%). Despite nutrition therapy, IMS was extremely low in both groups; median IMS was 1 in non-COVID patients and 0 in COVID patients. The rate of energy delivery ≥20 kcal/kg/day was significantly higher in patients with COVID-19 infections in the subgroup of ICU days ≤5 days and IMS ≤2. Having a dedicated ICU nutritionist/dietitian was significantly associated with appropriate energy delivery in patients both with and without COVID-19 infections, but not with protein delivery.

Conclusion: During the COVID-19 pandemic, patients with COVID-19 infections received higher energy and protein delivery. Generally low mobility levels highlight the need to optimize early mobilization with nutrition therapy in all ICU patients.

Keywords: COVID-19; Critical care; Energy; Mobility; Nutrition; Protein.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / epidemiology
COVID-19* / therapy
Critical Illness / therapy
Cross-Sectional Studies
Enteral Nutrition
Humans
Intensive Care Units
Pandemics
Prevalence