Feeding intolerance in critically ill patients with COVID-19
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. We examined 323 adult patients with COVID-19...
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Published in | Clinical nutrition (Edinburgh, Scotland) Vol. 41; no. 12; pp. 3069 - 3076 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
England
Elsevier Ltd
01.12.2022
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Subjects | |
Online Access | Get full text |
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Summary: | 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.
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.
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).
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. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Rebecca Liu: Conceptualization, Methodology, Data Curation, Writing – Original Draft; Mary Paz: Conceptualization, Methodology, Data Curation, Writing – Review & Editing, Project Administration; Layla Siraj: Formal Analysis, Visualization, Writing – Review & Editing; Taylor Boyd: Data Curation, Writing – Review & Editing; Silvia Salamone: Data Curation, Writing – Review & Editing; Thúy-L an V õ Lite: Formal Analysis, Visualization, Writing – Review & Editing; Krystle M . Leung: Data Curation, Writing – Review & Editing; J osue D. Chirinos: Data Curation, Writing – Review & Editing; Helen H. Shang: Data Curation, Writing – Review & Editing; Matthew J . Townsend: Data Curation, Writing – Review & Editing; Junsung Rho: Data Curation, Writing – Review & Editing; P eiyun Ni: Data Curation, Writing – Review & Editing; Kushi R anganath: Data Curation, Writing – Review & Editing; April D. Violante: Writing – Original Draft, Review & Editing; Zezhou Zhao: Data Curation, Writing – Review & Editing; Casey Silvernale: Data Curation, Writing – Review & Editing; Imama Ahmad: Data Curation, Writing – Review & Editing; Nira A. Krasnow: Data Curation, Writing – Review & Editing; Erica S. Barnett: Data Curation, Writing – Review & Editing; Mukesh Harisinghani: Supervision, Writing – Review & Editing; Braden Kuo: Methodology, Supervision, Writing – Review & Editing; Katharine E. Black: Methodology, Supervision, Writing – Review & Editing; Kyle Staller: Conceptualization, Methodology, Writing – Original Draft, Supervision. Author Contributions contributed equally |
ISSN: | 0261-5614 1532-1983 |
DOI: | 10.1016/j.clnu.2021.03.033 |