Nutritional Therapy in Critically Ill Patients with COVID-19: A Narrative Review
DOI:
https://doi.org/10.14306/renhyd.25.S2.1073Keywords:
Nutrition Therapy, Nutritional Status, COVID-19, SARS-CoV-2Abstract
Introduction: Combating the pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), better known as Coronavirus Disease 2019 (COVID-19), in all countries of the world has been a challenge. Most patients can be treated in home isolation, however elderly patients and/or with associated comorbidities have been demonstrating more severe conditions of the disease, requiring hospitalization, or even nutritional therapy and mechanical ventilation. Objective: To review the current evidence to establish better nutritional recommendations for critically ill patients with COVID-19.
Material and methods:This is a narrative review on nutritional therapy in critical patient with COVID-19. The scientific articles were searched in the databases U.S. National Library of Medicine (PubMed), as well as their respective terms in Portuguese and Spanish, and 40 articles were chosen, excluding the guidelines that were used to help better compose this article.
Results: The main findings were that age and non-communicable diseases are considered risk factors for mortality, with systemic arterial hypertension and diabetes mellitus being the main ones. These patients need special care, as well as constant assessment of nutritional status, since malnourished and obese patients have shown a high association with mortality and the use of mechanical ventilation. Nutritional therapy in the affected patients can improve clinical outcome and should be considered as first-line treatment and be more valued in the hospital setting. Although there is no recommendation for supplementation of vitamin C and D and the mineral zinc, these may bring benefits to the immune system of these patients and help in a better prognosis of COVID-19, however more studies are still needed to substantiate the dosage.
Conclusions: Further studies are needed, but it is important to bring these themes already exposed by some authors to stimulate discussions that might lead to improvements in the standardization of nutritional approaches.
References
(1) Campos LF, Barreto PA, Ceniccola GD, Gonçalves RC, de Matos LBN, Zambelli CMSF, et al. Parecer BRASPEN/ AMIB para o enfrentamento do COVID-19 em pacientes hospitalizados. BRASPEN J. 2020; 35(1): 3-5.
(2) Barazzoni R, Bischoff SC, Breda J, Wickramasinghe K, Krznaric Z, Nitzan D, et al. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Clin Nutr. 2020.
(3) Rastreador do COVID-19. Available in: https://bing.com/covid. Acess in July 12, 2020.
(4) Huang R, Zhu L, Xue L, Liu L, Yan X, Wang J, et al. Clinical findings of patients with coronavirus disease 2019 in Jiangsu province, China: A retrospective, multi-center study. PLoS Negl Trop Dis. 2020; 14(5): e0008280.
(5) Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020; 323 (11): 1061-1069.
(6) Martindale R, Patel JJ, Taylor B, Warren M, McClave SA. Nutrition Therapy in the Patient with COVID-19 Disease Requiring ICU Care. ASPEN. 2020. Available in: https://www.nutritioncare.org/uploadedFiles/Documents/Guidelines_and_Clinical_Resources/Nutrition%20Therapy%20COVID-19_SCCM-ASPEN.pdf. Acess in July 18, 2020.
(7) Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019; 38(1):48-79.
(8) Pedersen HP, Hildebrandt T, Poulsen A, Uslu B, Knudsen HH, Roed J, et al. Initial experiences from patients with COVID-19 on ventilatory support in Denmark. Dan Med J. 2020; 67(5): 1-4. A04200232.
(9) Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020; 323(16):1574-1581.
(10) Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020; 395(10239):1763-1770.
(11) Shahriarirad R, Khodamoradi Z, Erfani A, Hosseinpour H, Ranjbar K, Emami Y, et al. Epidemiological and clinical features of 2019 novel coronavirus diseases (COVID-19) in the South of Iran. BMC Infect Dis. 2020; 20(1):427.
(12) Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring). 2020.
(13) Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-481.
(14) Yu Y, Xu D, Fu S, Zhang J, Yang X, Xu L, et al. Patients with COVID-19 in 19 ICUs in Wuhan, China: a cross-sectional study. Crit Care. 2020; 24(1):219.
(15) Koh J, Shah SU, Chua PEY, Gui H, Pang J. Epidemiological and Clinical Characteristics of Cases During the Early Phase of COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2020; 7:295.
(16) Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020; 94:91-95.
(17) Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020; 109(5):531-538.
(18) Zhang J, Wu J, Sun X, Xue H, Shao J, Cai W, et al. Association of hypertension with the severity and fatality of SARS-CoV-2 infection: A meta-analysis. Epidemiol Infect. 2020; 148: e106.
(19) Lippi G, Wong J, Henry BM. Hypertension in patients with coronavirus disease 2019 (COVID-19): a pooled analysis. Pol Arch Intern Med. 2020; 130(4):304-309.
(20) Pranata R, Lim MA, Huang I, Raharjo SB, Lukito AA. Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia: A systematic review, meta-analysis, and meta-regression. J Renin Angiotensin Aldosterone Syst. 2020;21(2):1- 11.
(21) Rodriguez-Morales A, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis.2020; 34:101623.
(22) Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging (Albany NY). 2020;12(7):6049-6057.
(23) Espinosa OA, Zanetti AS, Antunes EF, Longhi FG, Matos TA, Battaglini PF. Prevalence of comorbidities in patients and mortality cases affected by SARS-CoV2: a systematic review and meta-analysis. Rev Inst Med Trop Sao Paulo. 2020; 62: e43.
(24) Hu Y, Sun J, Dai Z, Deng H, Li X, Huang Q, et al. Prevalence and severity of corona virus disease 2019 (COVID-19): A systematic review and meta-analysis. Clin Virol. 2020; 127:104371.
(25) Potere N, Valeriani E, Candeloro M, Tana M, Porreca E, Abbate A, et al. Acute complications and mortality in hospitalized patients with coronavirus disease 2019: a systematic review and meta-analysis. Crit Care. 2020; 24(1):389.
(26) Tahvildari A, Arbabi M, Farsi Y, Jamshidi P, Hasanzadeh S, Calcagno TM, et al. Clinical Features, Diagnosis, and Treatment of COVID-19 in Hospitalized Patients: A Systematic Review of Case Reports and Case Series. Front Med (Lausanne). 2020; 7:231.
(27) Yan Y, Yang Y, Wang F, Ren H, Zhang S, Shi X, et al. Clinical characteristics and outcomes of patients with severe covid-19 with diabetes. BMJ Open Diabetes Res Care. 2020; 8(1). pii: e001343.
(28) Zhu L, She ZG, Cheng X, Qin JJ, Zhang XJ, Cai J, et al. Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes. Cell Metab. 2020; 31(6):1068-1077.e3.
(29) Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ 2020; 369:m1985.
(30) Quah P, Li A, Phua J. Mortality rates of patients with COVID-19 in the intensive care unit: a systematic review of the emerging literature. Crit Care. 2020; 24(1):285.
(31) Du Y, Tu L, Zhu P, Mu M, Wang R, Yang P, et al. Clinical Features of 85 Fatal Cases of COVID-19 from Wuhan. A Retrospective Observational Study. Am J Respir Crit Care Med. 2020; 201(11):1372-1379.
(32) Li T, Zhang Y, Gong C, Wang J, Liu B, Shi L, et al. Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. Eur J Clin Nutr. 2020.
(33) Mao R, Qiu Y, He JS, Tan JY, Li XH, Liang J, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020; 5(7):667-678.
(34) Kumar VCS, Mukherjee S, Harne PS, Subedi A, Ganapathy MK, Patthipati VS, et al. Novelty in the gut: a systematic review and meta-analysis of the gastrointestinal manifestations of COVID-19. BMJ Open Gastroenterol. 2020; 7(1): e000417.
(35) Zhu J, Zhong Z, Ji P, Li H, Li B, Pang J, et al. Clinicopathological characteristics of 8697 patients with COVID-19 in China: a meta-analysis. Fam Med Community Health. 2020; 8(2): e000406.
(36) Grant MC, Geoghegan L, Arbyn M, Mohammed Z, McGuinness L, Clarke EL, at al. The prevalence of symptoms in 24,410 adults infected by the novel coronavirus (SARSCoV- 2; COVID-19): A systematic review and meta-analysis of 148 studies from 9 countries. PLoS One. 2020; 15(6): e0234765.
(37) Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020.
(38) Aziz M, Fatima R, Lee-Smith W, Assaly R. The association of low serum albumin level with severe COVID-19: a systematic review and meta-analysis. Crit Care. 2020; 24(1):255.
(39) Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020; e206775.
(40) Castro MG, Ribeiro PC, Souza IAO, Cunha HFR, Silva MHN, Rocha EEM. Diretriz Brasileira de Terapia Nutricional no Paciente Grave. BRASPEN J. 2018; 33(1): 2-36.
(41) Hasanin A, Mostafa M. Evaluation of fluid responsiveness during COVID-19 pandemic: what are the remaining choices? J Anesth. 2020; 1-7.
(42) Kazory A, Ronco C, McCullough PA. SARS-CoV-2 (COVID-19) and intravascular volume management strategies in the critically ill. Proc (Bayl Univ Med Cent). 2020; 0(0):1-6.
(43) Calder PC, Carr AC, Gombart AF, Eggersdorfer M. Optimal Nutritional Status for a Well-Functioning Immune System Is an Important Factor to Protect against Viral Infections. Nutrients. 2020; 12(4): 1181.
(44) Liu F, Zhu Y, Zhang J, Li Y, Peng Z. Intravenous high-dose vitamin C for the treatment of severe COVID-19: study protocol for a multicentre randomised controlled trial. BMJ Open 2020;10: e039519.
(45) Zhang L, Liu Y. Potential interventions for novel coronavirus in China: A systematic review. J Med Virol. 2020; 92(5):479-490.
(46) Grant WB, Lahore H, McDonnell SL, Baggerly CA, French CB, Aliano JL, et al. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients. 2020; 12(4): 988.
(47) Martucci G, McNally D, Parekh D, Zajic P, Tuzzolino F, Arcadipane A, et al. Trying to identify who may benefit most from future vitamin D intervention trials: a post hoc analysis from the VITDAL-ICU study excluding the early deaths. Crit Care. 2019; 23(1):200.
(48) National Heart, Lung, and Blood Institute PETAL Clinical Trials Network. Early High-Dose Vitamin D 3 for Critically Ill, Vitamin D-Deficient Patients. N Engl J Med. 2019; 381(26):2529-2540.
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