Safety and tolerance of enteral nutrition in COVID-19 critically ill patients, a retrospective study

Background: There is a lack of evidence about the tolerance of enteral nutrition (EN) in COVID-19 critically ill patients. However, several gastrointestinal manifestations related to COVID-19 have been described. The aims of this study were to analyze the incidence of gastrointestinal intolerance (GI) associated to EN (diarrhea, vomiting, gastroparesis and constipation) and to describe energy/protein provision along with biochemical alterations during the first week of EN. Methods: A retrospective cohort of COVID-19 critically ill patients under mechanical ventilation. We reported daily enteral nutrition infusion and gastrointestinal manifestations within the first week of intubation and enteral nutrition initiation. Results: Fifty-two patients were included; 40.3% were overweight and 46.2% were obese. During the first 7 days of EN, manifestations of GI intolerance such as vomiting, diarrhea and gastroparesis were present in 18 patients (32.4%). Hypernatremia (39%) was the most frequent electrolyte abnormality. Only Acute Kidney Injury (AKI) diagnosis was associated with a higher energy deficit on day 7. No associations between drug prescription and GI intolerance were observed. On day 4, 94.5% of patients were receiving more than 80% of energy requirements and 94.2% of protein requirements. Accumulated energy and protein deficits at day 3 were 2171.2 +/- 945 kcal and 114.9 +/- 49.2 g, respectively; and 2586.4 +/- 1151 kcal, 133.3 +/- 60.4 g at day 7. Conclusion: Enteral nutrition is feasible and well-tolerated in COVID-19 patients with mechanical ventilation within the first week of enteral nutrition initiation. More studies are needed to elucidate the impact of nutritional therapy on infection course and outcomes. (C) 2021 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Automated summary

This study investigated the tolerance of enteral nutrition in COVID-19 critically ill patients under mechanical ventilation. Results showed that gastrointestinal intolerance manifestations were present in 32.4% of patients within the first week of enteral nutrition initiation, with vomiting, diarrhea, and gastroparesis being the main symptoms. The majority of patients were able to meet over 80% of their energy and protein requirements by day 7.