4.7 Review

Metabolic Support in Acute Respiratory Distress Syndrome: A Narrative Review

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Summary: The COVID-19 pandemic has led to a significant increase in food insecurity among US households, particularly impacting vulnerable populations. Although temporary changes have been made to food and nutrition assistance policies and programs, some of these changes are expiring or contracting. ASPEN practitioners can play a crucial role in identifying high-risk clients, connecting them to resources, and contributing to the evidence base linking food insecurity and nutrition outcomes. They can also advocate for addressing the root social and structural determinants of food insecurity and the continuation of effective policy changes.

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Summary: In this study, outcomes were compared between mechanically ventilated patients with COVID-19 pneumonia and patients with other causes of pneumonia. The results showed that COVID-19 pneumonia patients had similar mortality rates as non-COVID-19 pneumonia patients within 90 days, but took longer to be liberated from mechanical ventilation.

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Jean Reignier et al.

Summary: This study investigated the optimal calorie and protein intake for acute phase of severe critical illness. The results showed that early restriction of calorie and protein intake can accelerate recovery and reduce complications, but it does not have a significant impact on mortality compared to standard targets.

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Jan Gunst et al.

Summary: Recent randomized controlled trials have shown that early full nutritional support does not benefit critically ill patients and may cause harm. The absence of benefit may not be due to low nutritional risk patients or low amino acid doses, as previously hypothesized. Mechanistic studies suggest that the lack of benefit is due to anabolic resistance and suppression of recovery-enhancing pathways induced by feeding. Large randomized controlled trials have not investigated the impact of different feeding strategies initiated after the acute phase in patients recovering from critical illness.

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Stefan Grund et al.

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Ryan Burslem et al.

Summary: Early reports indicate that predictive equations underestimate the energy requirements of critically ill patients with COVID-19. This can lead to underfeeding and malnutrition, which are associated with poor clinical outcomes. A review comparing measured and predicted energy expenditure in adult critically ill patients with COVID-19 suggests that commonly used predictive equations underestimate energy requirements and are not suitable alternatives to indirect calorimetry.

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Omorogieva Ojo et al.

Summary: This systematic review and meta-analysis evaluated the effects of enteral nutrition in critically ill patients with COVID-19. The results showed that early enteral nutrition significantly reduced the risk of mortality among these patients, while it did not significantly affect the length of hospital stay, length of ICU stay, and days on mechanical ventilation. Further studies are needed to examine the effect of early enteral nutrition in patients with COVID-19.

NUTRIENTS (2022)

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Nutritional Risk Assessment Scores Effectively Predict Mortality in Critically Ill Patients with Severe COVID-19

Constantin Bodolea et al.

Summary: This study evaluated the effectiveness of four nutritional risk assessment tools and explored the predictive value of CT-derived fat tissue and muscle mass measurements in predicting in-hospital mortality of critically ill patients with COVID-19-associated ARDS. The results showed that the nutritional risk assessment tools can accurately predict mortality, while fat tissue and muscle mass were not associated with increased mortality risk.

NUTRIENTS (2022)

Review Nutrition & Dietetics

Role of Diet and Nutrients in SARS-CoV-2 Infection: Incidence on Oxidative Stress, Inflammatory Status and Viral Production

Fatiha Brahmi et al.

Summary: COVID-19, caused by SARS-CoV-2, has had a significant impact on the world, making it crucial to find effective solutions. Research has shown that plant extracts have promising inhibiting effects on the coronavirus. Understanding the influence of diet on COVID-19 patients is also important. This review summarizes the influence of medicinal plant extracts on COVID-19, explores the possibilities of plant treatment/co-treatment and dietary interventions, discusses the impact of nutrient deficiencies on coronavirus susceptibility and complications, and covers major food groups that are effective against COVID-19 pathogenesis.

NUTRIENTS (2022)

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Prospective observational cohort study of reached protein and energy targets in general wards during the post-intensive care period: The PROSPECT-I study

Rianne Slingerland-Boot et al.

Summary: This study aims to describe energy and protein intake in detail over the entire post-ICU hospitalization period and explore associations between protein intake and clinical outcomes. The findings show that most patients did not meet energy and protein targets in the post-ICU hospitalization period. Nutrition performance was highly dependent on the route of nutrition, with the best intake observed in patients receiving (supplemental) enteral nutrition.

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Juan J. López-Gómez et al.

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Ka Man Fong et al.

Summary: This study found that glycemic control has different impacts on clinical outcomes in patients with and without diabetes. Compared to non-diabetic patients, diabetic patients have a more blunted response to hypo- and hyperglycemia and glucose variability. Glycemic control strategies should be reconsidered to avoid both hypoglycemia and hyperglycemia.

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Angela Feiner Solis et al.

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INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES (2022)

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Shuxun Jin et al.

Summary: COVID-19 infection commonly involves the gastrointestinal tract, with GI symptoms potentially appearing before respiratory symptoms. In addition to direct infection, patients are at risk of complications. Diarrhea is the most common GI symptom. Viral excretion in feces may contribute to fecal-oral transmission.

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Acute Respiratory Distress Syndrome 2022 2 Acute respiratory distress syndrome in adults: diagnosis, outcomes, long-term sequelae, and management

Ellen A. Gorman et al.

Summary: This paper reviews the diagnosis, management, outcomes, and long-term sequelae of ARDS, discussing potential limitations of its definition and evidence for future revisions. It also explores guideline recommendations and uncertainties in ARDS management, as well as the future of ARDS in the context of precision medicine and treatable traits.

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Constantine Vardavas et al.

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EUROPEAN RESPIRATORY REVIEW (2022)

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Eduardo Reyna-Villasmil et al.

Summary: This study assessed the association between patients' characteristics and comorbidities with the severity and mortality risk of SARS-CoV-2 infection. It found that age, smoking habit, and chronic diseases were associated with increased risk of hospitalization. Chronic pulmonary disease, cerebrovascular disease, and cardiovascular disease were likely to be associated with a higher risk of critical COVID-19. The highest risk of mortality was associated with cardiovascular disease, cerebrovascular disease, and chronic renal disease.

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Lesley L. Moisey et al.

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CRITICAL CARE (2022)

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Protein intake and outcome of critically ill patients: analysis of a large international database using piece-wise exponential additive mixed models

Wolfgang H. Hartl et al.

Summary: Proteins are an important part of medical nutrition therapy in critically ill patients. This study found that providing a standard protein intake during the late acute phase may improve patient outcomes compared to an exclusively low protein diet. However, there was no evidence that an early standard or high protein intake during the acute phase is associated with further improvement of outcomes.

CRITICAL CARE (2022)

Review Nutrition & Dietetics

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Najate Achamrah et al.

Summary: Indirect calorimetry is crucial for optimizing nutritional therapy, clinicians should be aware of its indications and contraindications to interpret results and tailor nutrition plans accordingly.

CLINICAL NUTRITION (2021)

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

Ivan Osuna-Padilla et al.

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.

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Paolo Formenti et al.

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Paul E. Wischmeyer et al.

Summary: Iatrogenic malnutrition and underfeeding are common in ICUs globally, with lack of objective data hindering timely nutrition delivery. Indirect calorimetry is highlighted as a solution to inaccurate predictive equations and the variability in metabolic needs, becoming a new standard of care for personalized nutrition in ICU and post-ICU settings.

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Nadine Sbaih et al.

Summary: Nutrition management for patients with acute respiratory failure, particularly those receiving non-invasive ventilation or high-flow nasal cannula, is crucial. Initial evaluation should include assessment of mental status, swallowing function, and severity of illness, with a goal to initiate oral diet within 24 hours. Failure to provide oral diet may indicate the need for further evaluation or endotracheal intubation. A multidisciplinary approach is recommended for effective nutrition management in these patients.

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K. R. Westerterp

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Sirak Petros et al.

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Ruan Cox et al.

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Carol A. Braunschweig et al.

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Vincent Fraipont et al.

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Anna Krzak et al.

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Renee D. Stapleton et al.

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Daren K. Heyland et al.

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Peter J. D. Andrews et al.

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