Table 2.
Nutrition-based strategies in critically ill patients that might potentially counteract COVID-19 clinical course [16].
| Type of Patients | Strategy | Energy Protein Supply |
Goal | Methods |
|---|---|---|---|---|
| Oral nutrition–possible and effective | Diet, Nutritional education |
25–30 kcal/kg/day; 1.2–2.0 g/kg/day. |
70% of nutritional requirements within 3 to 7 days | Encouraging patients to eat small meals In case of dysphagia-reducing The risk of aspiration (blending, semi-liquid diet) |
| Oral nutrition possible but not covering all requirements | diet ONS |
25–30 kcal/kg/day; 1.2–2.0 g/kg/day. |
70% of nutritional requirements within 3 to 7 days | 400–600 kcal of energy through ONS (customized if necessary) |
| CIP who cannot eat by mouth (recommended for patients receiving ECMO) | TEN | 10–20 mL/h or 10–20 kcal/h EN: adapted to coexisting diseases ^ |
Prevention of GI complications in mechanically ventilated Promotion of intestinal immune function; Maintaining the integrity of the intestinal barrier and function |
Nasogastric tube to start EN High risk of aspiration—post-pyloric feeding |
| CIP contraindicated to EN or EN who cannot reach the target amount of energy ^^ | PEN PN |
Glucose initially up to 5 mg/kg/min; Fat: duration of infusion ≥ 8 h |
When EN provide less than 60% of the target energy requirement | All-in-one preparation is recommended. |
ONS-oral nutritional supplements, PN—total parenteral nutrition, TEN—total enteral nutrition, ECMO—ExtraCorporeal Membrane Oxygenation, CIP—critically ill patients, PEN—partial enteral nutrition, GI-gastrointestinal, ^ (a) conventional formula for patients with normal gastrointestinal function with no elevated blood glucose and renal insufficiency, (b) Diabetes formula (c) Kidney disease formula, (d) High energy density formula (1.5–2 kcal/mL), (e) High dietary fiber formula with soluble dietary fiber (fructo-oligosaccharide, inulin), amount: 10–20 g fiber in divided portions within 24 h, (f) Short peptide formula, (g) Pulmonary disease type formula (high fat/low carbohydrate); ^^ Severe malnutrition or high nutritional risk (NRS 2002 ≥ 5 points or NUTRIC score ≥ 5 points). Patients with mild symptoms should take their meals orally or with the support of an ONS.