Division of Dietetics, Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands.
Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands.
Clin Nutr ESPEN. 2021 Jun;43:383-389. doi: 10.1016/j.clnesp.2021.03.019. Epub 2021 Apr 2.
BACKGROUND & AIMS: Different metabolic phases can be distinguished in critical illness, which influences nutritional treatment. Achieving optimal nutritional treatment during these phases in critically ill patients is challenging. COVID-19 patients seem particularly difficult to feed due to gastrointestinal problems. Our aim was to describe measured resting energy expenditure (mREE) and feeding practices and tolerance during the acute and late phases of critical illness in COVID-19 patients.
Observational study including critically ill mechanically ventilated adult COVID-19 patients. Indirect calorimetry (Q-NRG+, Cosmed) was used to determine mREE during the acute (day 0-7) and late phase (>day 7) of critical illness. Data on nutritional intake, feeding tolerance and urinary nitrogen loss were collected simultaneously. A paired sample t-test was performed for mREE in both phases.
We enrolled 21 patients with a median age of 59 years [44-66], 67% male and median BMI of 31.5 kg/m [25.7-37.8]. Patients were predominantly fed with EN in both phases. No significant difference in mREE was observed between phases (p = 0.529). Sixty-five percent of the patients were hypermetabolic in both phases. Median delivery of energy as percentage of mREE was higher in the late phase (94%) compared to the acute phase (70%) (p = 0.001). Urinary nitrogen losses were significant higher in the late phase (p = 0.003).
In both the acute and late phase, the majority of the patients were hypermetabolic and fed enterally. In the acute phase patients were fed hypocaloric whereas in the late phase this was almost normocaloric, conform ESPEN guidelines. No significant difference in mREE was observed between phases. Hypermetabolism in both phases in conjunction with an increasing loss of urinary nitrogen may indicate that COVID-19 patients remain in a prolonged acute, catabolic phase.
危重病患者可分为不同的代谢阶段，这会影响营养治疗。在危重病患者的这些阶段实现最佳营养治疗具有挑战性。由于胃肠道问题，COVID-19 患者似乎特别难以喂养。我们的目的是描述 COVID-19 患者在危重病的急性期和晚期测量静息能量消耗 (mREE) 以及喂养实践和耐受性。
这是一项包括接受机械通气的成年 COVID-19 危重病患者的观察性研究。使用间接热量测定法 (Q-NRG+，Cosmed) 在危重病的急性期 (第 0-7 天) 和晚期 (>第 7 天) 测定 mREE。同时收集营养摄入、喂养耐受性和尿氮损失的数据。对两个阶段的 mREE 进行配对样本 t 检验。
我们纳入了 21 名中位年龄为 59 岁 [44-66]、67%为男性和中位 BMI 为 31.5 kg/m [25.7-37.8] 的 COVID-19 患者。患者在两个阶段均主要接受肠内营养 (EN)。两个阶段的 mREE 无显著差异 (p = 0.529)。65%的患者在两个阶段均为高代谢。晚期的能量供给百分比明显高于急性期 (94%比 70%) (p = 0.001)。晚期的尿氮损失明显更高 (p = 0.003)。
在急性期和晚期，大多数患者均为高代谢且接受肠内喂养。在急性期患者接受低热量喂养，而在晚期则几乎接受正常热量喂养，符合 ESPEN 指南。两个阶段之间的 mREE 无显著差异。两个阶段的高代谢加上尿氮损失增加，可能表明 COVID-19 患者仍处于延长的急性期和分解代谢阶段。
