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Nutrition management for critically and acutely unwell hospitalised patients with coronavirus disease 2019 (COVID-19) in Australia and New Zealand.
Aust Crit Care. 2020 09; 33(5):399-406.AC

Abstract

Coronavirus disease 2019 (COVID-19) results from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical features and subsequent medical treatment, combined with the impact of a global pandemic, require specific nutritional therapy in hospitalised adults. This document aims to provide Australian and New Zealand clinicians with guidance on managing critically and acutely unwell adult patients hospitalised with COVID-19. These recommendations were developed using expert consensus, incorporating the documented clinical signs and metabolic processes associated with COVID-19, the literature from other respiratory illnesses, in particular acute respiratory distress syndrome, and published guidelines for medical management of COVID-19 and general nutrition and intensive care. Patients hospitalised with COVID-19 are likely to have preexisting comorbidities, and the ensuing inflammatory response may result in increased metabolic demands, protein catabolism, and poor glycaemic control. Common medical interventions, including deep sedation, early mechanical ventilation, fluid restriction, and management in the prone position, may exacerbate gastrointestinal dysfunction and affect nutritional intake. Nutrition care should be tailored to pandemic capacity, with early gastric feeding commenced using an algorithm to provide nutrition for the first 5-7 days in lower-nutritional-risk patients and individualised care for high-nutritional-risk patients where capacity allows. Indirect calorimetry should be avoided owing to potential aerosole exposure and therefore infection risk to healthcare providers. Use of a volume-controlled, higher-protein enteral formula and gastric residual volume monitoring should be initiated. Careful monitoring, particularly after intensive care unit stay, is required to ensure appropriate nutrition delivery to prevent muscle deconditioning and aid recovery. The infectious nature of SARS-CoV-2 and the expected high volume of patient admissions will require contingency planning to optimise staffing resources including upskilling, ensure adequate nutrition supplies, facilitate remote consultations, and optimise food service management. These guidelines provide recommendations on how to manage the aforementioned aspects when providing nutrition support to patients during the SARS-CoV-2 pandemic.

Authors+Show Affiliations

Intensive Care Research, Royal Adelaide Hospital, Adelaide, Australia; Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia. Electronic address: lee-anne.chapple@adelaide.edu.au.Allied Health (Clinical Nutrition), Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, The University of Melbourne, Parkville, Australia. Electronic address: kate.fetterplace@mh.org.au.Nutrition and Dietetics, Auckland City Hospital, Auckland, New Zealand; Surgical and Translational Research (STaR) Centre, University of Auckland, Auckland, New Zealand; Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand. Electronic address: VarshaA@adhb.govt.nz.Intensive Care Unit, The Alfred Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia. Electronic address: aidan.burrell@monash.edu.Department of Infection and Epidemiology, Alfred Health, Melbourne, Australia. Electronic address: allen.cheng@monash.edu.Nutrition and Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Patient-Centred Health Services, Menzies Health Institute, Queensland, Australia. Electronic address: peter.collins@griffith.edu.au.Dietetics Department, Princess Alexandra Hospital, Brisbane, Australia; Mater Research Institute, The University of Queensland, Brisbane, Australia. Electronic address: raeesa.doola@health.qld.gov.au.Nutrition and Dietetics Department, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Australia. Electronic address: suzie.ferrie@health.nsw.gov.au.School of Nursing and Midwifery and Menzies Health Institute, Griffith University, Gold Coast, Australia; Gold Coast Health, Southport, Australia. Electronic address: a.marshall@griffith.edu.au.Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia; Nutrition Department, Alfred Hospital, Melbourne, Australia. Electronic address: emma.ridley@monash.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32682671

Citation

Chapple, Lee-Anne S., et al. "Nutrition Management for Critically and Acutely Unwell Hospitalised Patients With Coronavirus Disease 2019 (COVID-19) in Australia and New Zealand." Australian Critical Care : Official Journal of the Confederation of Australian Critical Care Nurses, vol. 33, no. 5, 2020, pp. 399-406.
Chapple LS, Fetterplace K, Asrani V, et al. Nutrition management for critically and acutely unwell hospitalised patients with coronavirus disease 2019 (COVID-19) in Australia and New Zealand. Aust Crit Care. 2020;33(5):399-406.
Chapple, L. S., Fetterplace, K., Asrani, V., Burrell, A., Cheng, A. C., Collins, P., Doola, R., Ferrie, S., Marshall, A. P., & Ridley, E. J. (2020). Nutrition management for critically and acutely unwell hospitalised patients with coronavirus disease 2019 (COVID-19) in Australia and New Zealand. Australian Critical Care : Official Journal of the Confederation of Australian Critical Care Nurses, 33(5), 399-406. https://doi.org/10.1016/j.aucc.2020.06.002
Chapple LS, et al. Nutrition Management for Critically and Acutely Unwell Hospitalised Patients With Coronavirus Disease 2019 (COVID-19) in Australia and New Zealand. Aust Crit Care. 2020;33(5):399-406. PubMed PMID: 32682671.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nutrition management for critically and acutely unwell hospitalised patients with coronavirus disease 2019 (COVID-19) in Australia and New Zealand. AU - Chapple,Lee-Anne S, AU - Fetterplace,Kate, AU - Asrani,Varsha, AU - Burrell,Aidan, AU - Cheng,Allen C, AU - Collins,Peter, AU - Doola,Ra'eesa, AU - Ferrie,Suzie, AU - Marshall,Andrea P, AU - Ridley,Emma J, Y1 - 2020/07/02/ PY - 2020/04/27/received PY - 2020/05/22/revised PY - 2020/06/26/accepted PY - 2020/7/20/pubmed PY - 2020/9/12/medline PY - 2020/7/20/entrez KW - Artificial feeding KW - COVID-19 KW - Critical illness KW - Nutrition KW - Pandemic SP - 399 EP - 406 JF - Australian critical care : official journal of the Confederation of Australian Critical Care Nurses JO - Aust Crit Care VL - 33 IS - 5 N2 - Coronavirus disease 2019 (COVID-19) results from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical features and subsequent medical treatment, combined with the impact of a global pandemic, require specific nutritional therapy in hospitalised adults. This document aims to provide Australian and New Zealand clinicians with guidance on managing critically and acutely unwell adult patients hospitalised with COVID-19. These recommendations were developed using expert consensus, incorporating the documented clinical signs and metabolic processes associated with COVID-19, the literature from other respiratory illnesses, in particular acute respiratory distress syndrome, and published guidelines for medical management of COVID-19 and general nutrition and intensive care. Patients hospitalised with COVID-19 are likely to have preexisting comorbidities, and the ensuing inflammatory response may result in increased metabolic demands, protein catabolism, and poor glycaemic control. Common medical interventions, including deep sedation, early mechanical ventilation, fluid restriction, and management in the prone position, may exacerbate gastrointestinal dysfunction and affect nutritional intake. Nutrition care should be tailored to pandemic capacity, with early gastric feeding commenced using an algorithm to provide nutrition for the first 5-7 days in lower-nutritional-risk patients and individualised care for high-nutritional-risk patients where capacity allows. Indirect calorimetry should be avoided owing to potential aerosole exposure and therefore infection risk to healthcare providers. Use of a volume-controlled, higher-protein enteral formula and gastric residual volume monitoring should be initiated. Careful monitoring, particularly after intensive care unit stay, is required to ensure appropriate nutrition delivery to prevent muscle deconditioning and aid recovery. The infectious nature of SARS-CoV-2 and the expected high volume of patient admissions will require contingency planning to optimise staffing resources including upskilling, ensure adequate nutrition supplies, facilitate remote consultations, and optimise food service management. These guidelines provide recommendations on how to manage the aforementioned aspects when providing nutrition support to patients during the SARS-CoV-2 pandemic. SN - 1036-7314 UR - https://www.unboundmedicine.com/medline/citation/32682671/Nutrition_management_for_critically_and_acutely_unwell_hospitalised_patients_with_coronavirus_disease_2019__COVID_19__in_Australia_and_New_Zealand_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1036-7314(20)30244-7 DB - PRIME DP - Unbound Medicine ER -