Division of Dietetics, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands.
Division of Dietetics, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands.
Clin Nutr. 2022 Dec;41(12):2903-2909. doi: 10.1016/j.clnu.2022.04.001. Epub 2022 Apr 6.
BACKGROUND & AIMS: Critically ill COVID-19 patients seem hypermetabolic and difficult to feed enterally, due to gastro-intestinal (GI) symptoms such as high gastric residual volumes (GRV) and diarrhea. Our aim was to describe the association of nutritional intake and GI symptoms during first 14 days of ICU admission.
Observational study including critically ill adult COVID-19 patients. Data on nutritional intake [enteral nutrition (EN) or parenteral nutrition] and GI symptoms were collected during 14 days after ICU admission. Target energy and protein feeding goals were calculated conform ESPEN guidelines. GI symptoms included GRV (ml/d), vomiting, abdominal distension, and faeces (ml/d). High GRV's were classified as ≥2 times ≥150 ml/d and diarrhea as Bristol stool chart ≥6. GI symptoms were defined as mild if at least one symptom occurred and as moderate when ≥2 symptoms occurred. Acute gastrointestinal injury (AGI) grades of III were classified as GI dysfunction and grades of IV were considered as GI failure with severe impact on distant organs. Linear mixed model analysis was performed to explore the development of nutritional intake and GI symptoms over time at day (D) 0, 4, 10, and 14.
One hundred and fifty patients were included [75% male; median age 64 years (IQR 54-70)]. BMI upon admission was 28 kg/m (IQR 25-33), of which 43% obese (BMI > 30 kg/m). Most patients received EN during admission (98% D4; 96% D10-14). Mean energy goals increased from 87% at D4 to 93% D10-14 and protein goals (g/kg) were increasingly achieved during admission (84% D4; 93% D10-14). Presence of moderate GI symptoms decreased (10% D0; 6% D4-10; 5% D14), reversely mild GI symptoms increased. Occurrence of GI dysfunction fluctuated (1% D0; 18% D4; 12% D10; 8% D14) and none of patients developed grade IV GI failure. Development of high GRV fluctuated (5% D0; 23% D4; 14% D10; 8% D14) and occurrence of diarrhea slightly increased during admission (5% D0; 22% D4; 25% D10; 27% D14). Linear mixed models showed only an association between AGI grades III and lower protein intake at day 10 (p = 0.020).
Occurrence of GI symptoms was limited and seems no major barrier for EN in our group of critically COVID-19 patients. Nutritional intake was just below requirements during the first 14 days of ICU admission. The effect on nutritional status remains to be studied.
由于胃肠道（GI）症状，如高胃残留量（GRV）和腹泻，危重症 COVID-19 患者似乎代谢亢进且难以进行肠内喂养。我们的目的是描述 ICU 入院后前 14 天内营养摄入和 GI 症状之间的关联。
这是一项包括危重症成年 COVID-19 患者的观察性研究。在 ICU 入院后 14 天内收集了营养摄入[肠内营养（EN）或肠外营养]和 GI 症状的数据。目标能量和蛋白质喂养目标根据 ESPEN 指南计算。GI 症状包括 GRV（ml/d）、呕吐、腹胀和粪便（ml/d）。高 GRV 被定义为≥2 次≥150 ml/d，腹泻为布里斯托粪便图表≥6。如果至少发生一种症状，则将 GI 症状定义为轻度，如果发生≥2 种症状，则将其定义为中度。III 级急性胃肠损伤（AGI）被归类为胃肠功能障碍，IV 级被认为是胃肠衰竭，对远处器官有严重影响。线性混合模型分析用于探索从第 0、4、10 和 14 天开始的营养摄入和 GI 症状的发展。
共纳入 150 名患者[75%为男性；中位年龄 64 岁（IQR 54-70）]。入院时 BMI 为 28 kg/m（IQR 25-33），其中 43%为肥胖（BMI>30 kg/m）。大多数患者在住院期间接受 EN（98% D4；96% D10-14）。能量目标从第 4 天的 87%增加到第 10-14 天的 93%，蛋白质目标（g/kg）在住院期间逐渐达到（84% D4；93% D10-14）。中度 GI 症状的发生率下降（10% D0；6% D4-10；5% D14），轻度 GI 症状的发生率增加。胃肠功能障碍的发生情况波动（1% D0；18% D4；12% D10；8% D14），无患者出现 IV 级胃肠衰竭。高 GRV 的发生情况波动（5% D0；23% D4；14% D10；8% D14），腹泻的发生率在住院期间略有增加（5% D0；22% D4；25% D10；27% D14）。线性混合模型显示，仅在第 10 天时，AGI 级 III 与较低的蛋白质摄入之间存在关联（p=0.020）。
在我们的 COVID-19 危重症患者组中，GI 症状的发生较为有限，似乎不是 EN 的主要障碍。在 ICU 入院后的前 14 天内，营养摄入仅略低于要求。其对营养状况的影响仍有待研究。
