[Nutritional support for critically ill patients with COVID-19].Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020 May 25; 49(3):347-355.ZD
Nutritional support is an indispensable part in the treatment of critically ill patients with coronavirus disease 2019 (COVID-19). Critically ill COVID-19 patients are often in a state of high inflammation, high stress, high catabolism, and their energy consumption increases significantly. All critically ill patients with COVID-19 should be screened for nutritional risk with NRS-2002 or Nutric tool in the early stage. If there is a risk of malnutrition, subjective global assessment (SGA) or Global Leadership Initiative on Malnutrition (GLIM) are further used for malnutrition assessment. After assessment, the daily energy, protein, electrolyte and liquid quantity needed by the patients should be determined according to the actual condition. Then, according to the degree of gastrointestinal function impairment in patients, the oral nutrition supplement, enteral nutrition, parenteral nutrition or their combination are selected for nutritional support. For patients with normal gastrointestinal function who require prone position ventilation or receive extracorporeal membrane oxygenation (ECMO) treatment, enteral nutrition is recommended as the first choice. In addition, in the process of nutrition implementation, it is necessary to closely monitor the adverse reactions such as abdominal distention, diarrhea, regurgitation, phlebitis and liver function damage, timely adjust the nutrition program to ensure the smooth implementation of nutritional support. Based on the metabolic characteristics of critically ill patients with COVID-19, this paper makes a summary and suggestion on the following perspectives such as nutritional risk screening and assessment, target amount of nutritional treatment, nutritional intervention and treatment, nutritional support of special populations, and common adverse reactions in nutritional support treatment, so as to provide reference for individualized nutritional support therapy of critically ill patients with COVID-19.