4CPS-377 Appropriateness of nutritional support for patients with invasive mechanical ventilation with COVID-19 disease requiring intensive care

Abstract

Background and importance Nutritional management in the intensive care unit (ICU) of patients with COVID-19 can influence their recovery. Several guides about nutritional support have appeared in the past few months Aim and objectives To assess the appropriateness of nutritional management for COVID-19 patients in the ICU requiring invasive mechanical ventilation (IMV) through compliance with the recommendations of the Spanish Society for Intensive Care (SEMICYUC), the European Society for Clinical Nutrition and Metabolism (ESPEN) and the American Society for Parenteral and Enteral Nutrition (ASPEN). Material and methods An observational retrospective study was conducted between 2 March and 13 May 2020. Patient data were taken from the clinical records. Demographic variables were age and sex; clinical variables were days until the start of artificial nutrition (AN), duration and type of enteral (EN) or parenteral nutrition (PN), body mass index (BMI), calorie intake/kg/day, protein/kg/day on the first and fifth days, increase in markers of hepatic cholestasis when duration of NP was >14 days, length of ICU stay and death. Results 41 patients were included, 75.6%(n=31) men, and average age was 59.6±12,2 years. Median time to start of AN was 1 (0–6) day. 34.1% (n=14) of patients were obese, of whom 21% (n=3) were morbidly obese (average BMI 44.86±6.4). Average total kcal/kg/day and protein/kg/day on the first and fifth days of nutrition were 21.9±7.5 kcal/kg/day and 1.35±0.6 g protein/kg/day and 23.5±9.8 kcal/kg/day and 1.9±3.2 g protein/kg/day, respectively. Only 17% (n=7) started AN with EN, which was hypercaloric/hyperproteic (n=3) and normocaloric/normoproteic (n=4). At any time during hospital stay, 97.5% of patients had PN with a median of 14.5 (2–52) days. 20 people had PN >14 days. Alkaline phosphatase remained increased for 11 of them with a median of 13 (3–38) days. Direct bilirubin was elevated in all patients. 34 patients died and 26 remained on PN until the day they died. Conclusion and relevance During the first day, AN accomplished the recommendations (20 kcal/kg/day and 1.2–1.3 g protein/kg/day). On the fifth day, total kilocalories did not achieve the recommended values (25 kcal/kg/day), although protein/kg/day was higher than the guidelines (1.5 kcal/kg/ day). The reason might be the increasing protein request of these patients. High doses of muscle relaxants could prevent proper functionality of digestive tube and low use of EN. It may be important to discuss the suitability of maintenance of AN for patients with a short life expectancy.