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Feeding intolerance in critically ill patients with COVID-19.

Authors :
Liu R
Paz M
Siraj L
Boyd T
Salamone S
Lite TV
Leung KM
Chirinos JD
Shang HH
Townsend MJ
Rho J
Ni P
Ranganath K
Violante AD
Zhao Z
Silvernale C
Ahmad I
Krasnow NA
Barnett ES
Harisinghani M
Kuo B
Black KE
Staller K
Source :
Clinical nutrition (Edinburgh, Scotland) [Clin Nutr] 2022 Dec; Vol. 41 (12), pp. 3069-3076. Date of Electronic Publication: 2021 Mar 29.
Publication Year :
2022

Abstract

Background & Aims: Early reports suggest significant difficulty with enteral feeding in critically ill COVID-19 patients. This study aimed to characterize the prevalence, clinical manifestations, and outcomes of feeding intolerance in critically ill patients with COVID-19.<br />Methods: We examined 323 adult patients with COVID-19 admitted to the intensive care units (ICUs) of Massachusetts General Hospital between March 11 and June 28, 2020 who received enteral nutrition. Systematic chart review determined prevalence, clinical characteristics, and hospital outcomes (ICU complications, length of stay, and mortality) of feeding intolerance.<br />Results: Feeding intolerance developed in 56% of the patients and most commonly manifested as large gastric residual volumes (83.9%), abdominal distension (67.2%), and vomiting (63.9%). Length of intubation (OR 1.05, 95% CI 1.03-1.08), ≥1 GI symptom on presentation (OR 0.76, 95% CI 0.59-0.97), and severe obesity (OR 0.29, 95% CI 0.13-0.66) were independently associated with development of feeding intolerance. Compared to feed-tolerant patients, patients with incident feeding intolerance were significantly more likely to suffer cardiac, renal, hepatic, and hematologic complications during their hospitalization. Feeding intolerance was similarly associated with poor outcomes including longer ICU stay (median [IQR] 21.5 [14-30] vs. 15 [9-22] days, P < 0.001), overall hospitalization time (median [IQR] 30.5 [19-42] vs. 24 [15-35], P < 0.001) and in-hospital mortality (33.9% vs. 16.1%, P < 0.001). Feeding intolerance was independently associated with an increased risk of death (HR 3.32; 95% CI 1.97-5.6).<br />Conclusions: Feeding intolerance is a frequently encountered complication in critically ill COVID-19 patients in a large tertiary care experience and is associated with poor outcomes.<br />Competing Interests: Conflict of interest KS has received research support from AstraZeneca, Takeda, and Gelesis, has served as a speaker for Shire, and has served as a consultant to Gelesis, Synergy, and Shire.<br /> (Copyright © 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Details

Language :
English
ISSN :
1532-1983
Volume :
41
Issue :
12
Database :
MEDLINE
Journal :
Clinical nutrition (Edinburgh, Scotland)
Publication Type :
Academic Journal
Accession number :
33934924
Full Text :
https://doi.org/10.1016/j.clnu.2021.03.033