Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 14 Medyków Street, 40-752 Katowice, Poland.
Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
Nutrients. 2023 Feb 22;15(5):1086. doi: 10.3390/nu15051086.
Medical nutrition should be tailored to cover a patient's needs, taking into account medical and organizational possibilities and obstacles. This observational study aimed to assess calories and protein delivery in critically ill patients with COVID-19. The study group comprised 72 subjects hospitalized in the intensive care unit (ICU) during the second and third SARS-CoV-2 waves in Poland. The caloric demand was calculated using the Harris-Benedict equation (HB), the Mifflin-St Jeor equation (MsJ), and the formula recommended by the European Society for Clinical Nutrition and Metabolism (ESPEN). Protein demand was calculated using ESPEN guidelines. Total daily calorie and protein intakes were collected during the first week of the ICU stay. The median coverages of the basal metabolic rate (BMR) during day 4 and day 7 of the ICU stay reached: 72% and 69% (HB), 74% and 76% (MsJ), and 73% and 71% (ESPEN), respectively. The median fulfillment of recommended protein intake was 40% on day 4 and 43% on day 7. The type of respiratory support influenced nutrition delivery. A need for ventilation in the prone position was the main difficulty to guarantee proper nutritional support. Systemic organizational improvement is needed to fulfill nutritional recommendations in this clinical scenario.
医学营养应根据患者的需求进行调整,同时考虑到医疗和组织方面的可能性和障碍。本观察性研究旨在评估 COVID-19 重症患者的热量和蛋白质供给情况。研究组包括在波兰第二波和第三波 SARS-CoV-2 疫情期间入住重症监护病房(ICU)的 72 名患者。采用 Harris-Benedict 方程(HB)、Mifflin-St Jeor 方程(MsJ)和欧洲临床营养与代谢学会(ESPEN)推荐的公式计算热量需求。采用 ESPEN 指南计算蛋白质需求。在 ICU 入住的第一周收集患者的每日总热量和蛋白质摄入量。ICU 入住第 4 天和第 7 天的基础代谢率(BMR)覆盖中位数分别为:72%和 69%(HB)、74%和 76%(MsJ)以及 73%和 71%(ESPEN)。推荐蛋白质摄入量的中位数在第 4 天和第 7 天分别为 40%和 43%。呼吸支持的类型影响营养供给。俯卧位通气是保证适当营养支持的主要困难。需要进行系统性的组织改进,以满足该临床情况下的营养建议。