Nutritional support for patients with new coronavirus infection
22 Jun 2021-Vol. 12, Iss: 2, pp 102-109
TL;DR: In this article, a review of nutritional support for patients with COVID-19 during treatment and rehabilitation is presented, focusing on the gradual achievement of target protein and energy levels, as well as the preferential use of the enteral method of delivering food components.
Abstract: The novel coronavirus infection (COVID-19) pandemic has become an unprecedented threat to the lives of those affected and has increased the burden on the healthcare system in most countries. The severity of COVID-19 is not always predictable. However, comorbid pathology and advanced age are risk factors for a severe course of the disease with the development of multiple organ failure. When treating COVID-19, clinicians place particular emphasis on nutritional support as part of intensive care. Correction of nutritional status is also important in the rehabilitation of patients with the syndrome after intensive care. The aim of the review was to show the need for a differentiated approach to nutritional support for patients with COVID-19 during treatment and rehabilitation. From more than 200 originally selected literature sources from various databases (Scopus, Web of science, RSCI, etc.), 49 publications were selected for analysis, mostly published over the past 5 years. Earlier articles were used if they were still relevant to clinicians. The review provides methods for assessing the nutritional status of patients with COVID-19. It is emphasized that patients with comorbid pathology and elderly patients often develop malnutrition, which progresses over the disease. The article discusses in detail the issues of correction of malnutrition, depending on the severity of the disease and the stage of treatment. The effectiveness of rehabilitation is enhanced with adequate nutritional support. Current approaches to providing COVID-19 patients with nutrients and energy include a gradation of nutritional support prescription depending on the severity of the disease. Particular attention is paid to the gradual achievement of target protein and energy levels, as well as the preferential use of the enteral method of delivery of food components. Continuity of nutritional status correction at the outpatient, inpatient and rehabilitation stages improves the quality of care for patients with COVID-19.
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TL;DR: Analyzing several papers published by foreign colleagues and the own experience in the Department of Anesthesiology and Intensive Care for Patients with a New Coronavirus Infection COVID-19 at the Russian Academy of Sciences Central Clinical Hospital in Moscow in 2020 found ways in which to provide nutritional support based on the prevalent causes of protein-energy malnutrition, taking into account the patient's individual needs and the extent of respiratory support.
Abstract: Significance: The COVID-19 pandemic, declared by WHO on March 11, 2020, has made significant adjustments to the principles of organizing medical care, including treatment, nutrition and care of patients in infectious hospitals. The disease has different clinical courses: from mild asymptomatic to extremely severe, requiring aggressive medical intervention such as organ replacement therapy to replace vital body functions. [1]
The spread of viral infection was global, but the pathophysiological aspects of the course of COVID-19 have not been studied enough. The development of ARDS and systemic inflammatory response syndrome as part of the severe course of the disease is accompanied by severe metabolic disorders that require close attention. It is necessary to correct the clinical manifestations of organ dysfunction under severe hypercatabolism. Considerable importance is given to the peculiarities of providing nutritional support to patients using specialized nutritional mixtures to prevent conditions that worsen the prognosis of recovery and survival of patients. [2]
The target cells of the virus are angiotensin-converting enzyme receptors of the respiratory, nervous, urinary, cardiovascular systems and organs of the gastrointestinal tract. [3] Consequently, the site of the infection at different organs and systems gives rise to the phenomena of respiratory failure and many heterogeneous clinical manifestations of the disease, which can affect all ties in the pathogenesis of nutritional deficiency. Malnutrition is usually due to the mismatch between the intake and consumption of nutrients, micro-and macroelements. [4]
Aim: To systematize ways in which we provide nutritional support based on the prevalent causes of protein-energy malnutrition, taking into account the patient's individual needs and the extent of respiratory support. We analyzed several papers published by foreign colleagues and our own experience in the Department of Anesthesiology and Intensive Care for Patients with a New Coronavirus Infection COVID-19 at the Russian Academy of Sciences Central Clinical Hospital in Moscow in 2020.
References
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Fei Zhou1, Ting Yu, Ronghui Du, Guohui Fan2, Ying Liu, Zhibo Liu1, Jie Xiang3, Yeming Wang4, Bin Song, Xiaoying Gu2, Xiaoying Gu1, Lulu Guan, Yuan Wei, Li Hui1, Xudong Wu, Jiuyang Xu5, Shengjin Tu, Yi Zhang1, Hua Chen, Bin Cao •
TL;DR: Wang et al. as discussed by the authors used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death, including older age, high SOFA score and d-dimer greater than 1 μg/mL.
20,189 citations
Nanshan Chen1, Min Zhou2, Xuan Dong1, Jie-Ming Qu2, Fengyun Gong1, Yang Han1, Yang Qiu3, Jingli Wang1, Ying Liu1, Yuan Wei1, Jia'an Xia1, Ting Yu1, Xinxin Zhang2, Li Zhang1 •
TL;DR: Characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia, and further investigation is needed to explore the applicability of the Mu LBSTA scores in predicting the risk of mortality in 2019-nCoV infection.
16,282 citations
TL;DR: The COVID-19 pandemic represents the greatest global public health crisis of this generation and, potentially, since the pandemic influenza outbreak of 1918 and both the need and capability to produce high-quality evidence even in the middle of a pandemic.
Abstract: Importance The pandemic of coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents an unprecedented challenge to identify effective drugs for prevention and treatment. Given the rapid pace of scientific discovery and clinical data generated by the large number of people rapidly infected by SARS-CoV-2, clinicians need accurate evidence regarding effective medical treatments for this infection. Observations No proven effective therapies for this virus currently exist. The rapidly expanding knowledge regarding SARS-CoV-2 virology provides a significant number of potential drug targets. The most promising therapy is remdesivir. Remdesivir has potent in vitro activity against SARS-CoV-2, but it is not US Food and Drug Administration approved and currently is being tested in ongoing randomized trials. Oseltamivir has not been shown to have efficacy, and corticosteroids are currently not recommended. Current clinical evidence does not support stopping angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in patients with COVID-19. Conclusions and Relevance The COVID-19 pandemic represents the greatest global public health crisis of this generation and, potentially, since the pandemic influenza outbreak of 1918. The speed and volume of clinical trials launched to investigate potential therapies for COVID-19 highlight both the need and capability to produce high-quality evidence even in the middle of a pandemic. No therapies have been shown effective to date.
2,143 citations
TL;DR: The screening system appears to be able to distinguish between trials with a positive effect vs no effect, and it can therefore probably also identify patients who are likely to benefit from nutritional support.
2,013 citations
TL;DR: The Mini Nutritional Assessment has recently been designed and validated to provide a single, rapid assessment of nutritional status in elderly patients in outpatient clinics, hospitals, and nursing homes and was found to be predictive of mortality and hospital cost.
1,540 citations