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Nutrition Therapy Provision for Patients with COVID-19

Information extracted from ASPEN’s “Nutrition Therapy in the Patient with COVID-19 Disease Requiring ICU Care”

Rationale: Early nutrition is important for improving outcomes. Please use the guidelines provided below to optimize nutrition for COVID-19 patients.

  Tube feeding:

  • In the first 24-36 hours, provide a minimum of 10-20 ml/hour of Fibersource HN or Isosource 1.5 (Dietitians will recommend adjustments as needed) and advance as tolerated to goal over 7-10 days UNLESS:
    • If patient presents with severe GI symptoms (severe nausea, vomiting, diarrhea, abdominal pain or distention, GI bleeding, dilated bowel loops, or pneumatosis intestinalis), consider prokinetic agents to help or TPN. 
    • If using pressor support, provide Isosource HN tube feeding; if pressor support is high or increasing, consider prokinetic agents or TPN. 
    • If high pressure respiratory support, consider TPN. 
  • Do NOT check gastric residuals. 
  • If unable to advance the tube feeding rate past 10-20 ml/hour within 3-5 days, consider supplemental TPN. 

Intolerance:

  • Intolerance is common. Try prokinetic agents or consider TPN. 

Refeeding concerns: 

  • If patient is known to have large weight loss or poor intake for ≥ 1 week, consider advancing slowly while monitoring phosphorus, potassium, and magnesium labs for at least 3 days. The dietitians can help with more patient-specific recommendations. 

TPN:

  • Per ASPEN recommendations, consider holding lipids for 1 week 

Prone Positioning:

  • Tube feeding is still recommended provided the patient does not have contraindications listed above. 
  • Keep the head of bed elevated to 10-25 degrees. 

ECMO:

  • Early tube feeding is still recommended and typically tolerated within 36 hours as able. If intolerance arises, use TPN. 

Diet Progression:

  • Once patient can eat solid foods, progress diet to Soft Dysphagia Advanced diet until patient is moved off the COVID unit.

April 13, 2020