Evaluation of the Nutritional Status of COVID-19 Patients Treated in the Intensive Care Unit

INTRODUCTION: Covid-19 presents with a wide variety of clinical manifestations, and these patients are also admitted to intensive care units (ICU). Long ICU stays, gastrointestinal involvement, and prolonged hospital stays can result in hypomotility and ischemia of the intestines, which may further result in increased mortality. In severe ARDS cases, the prone position is applied to the patients. In patients in the prone position, deep sedation with muscle relaxants and parenteral nutrition is generally preferred. We aimed to evaluate the Nutritional Risk Screening (NRS 2002) score at first hospitalization, the nutritional status of the patients, and their relationship with mortality in patients followed up for Covid-19.
METHODS: In this study, after the approval of the ethics committee (FSMEAH-KAEK2021/28), patients aged 18 years and over who had Covid-19 PCR test positivity and who were hospitalized in the ICU for more than 24 hours between 01.03.2020-28.02.2022 were included. Demographic data, APACHE II, SOFA, SAPS II, NRS 2002 scores, comorbidities, need for mechanical ventilation (MV), non-invasive MV or high-flow oxygen therapy, length of stay, enteral, parenteral, or oral nutrition and durations, need for prone positioning, time of first nutrition, inotrope requirement, discharge from the ICU, and mortality were recorded. SPSS v20.0 was used for statistical analysis.
RESULTS: Sixty-nine patients were studied in the study (35 male (50.7%), 34 female (49.3%)). The mean age of the patients was 72.2±12.3. The prone position was applied in 87% of patients on invasive mechanical ventilators, 30.4% of patients on non-invasive mechanical ventilators, and 7.2% of patients on high-flow oxygen therapy. Enteral nutrition rate was 89.9%, parenteral nutrition rate was 43.5%. Time to first nutrition was 1.4±0.6 days, and time to first enteral nutrition was 1.7±1.0 days. The number of patients who used vasopressor agents was 52 (75.4%), and the mortality rate was 69.6%. The mean NRS 2002 score was 4.2±0.9. SOFA score, IMV, NIMV, prone positioning, and vasopressor agent use were high in the mortality group.
DISCUSSION AND CONCLUSION: The presence of extrapulmonary involvement, associated dysmotility, deep sedation, the use of muscle relaxants, and the resulting intolerance affect the complications of ICU admissions and ICU discharge in Covid-19 disease. Therefore, ICU management and the nutritional state of Covid-19 patients can influence ICU discharge and mortality.