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.