4CPS-379\u2005Parenteral nutrition management in coronavirus critical patients: case report

Abstract

Background and importance Parenteral nutritional (PN) support in critically ill patients with SARS-CoV-2 infection is a currently unknown field of study with little published literature to generate scientific evidence. Aim and objectives To carry out a descriptive study of all patients with SARS-CoV-2 infection admitted to the ICU and resuscitation unit with invasive mechanical ventilation and central PN between March and June 2020 by the nutrition unit of the pharmacy service. Material and methods A retrospective longitudinal study was carried out in a tertiary hospital. The clinical situation was reviewed, and the contributions of the artificial nutrition preparations were studied. Energetic requirements were calculated with the Harris–Benedict equation corrected for stress factor and protein requirements with weight adjusted by protein factor. Categorical variables are presented as percentages and continuous variables as mean (SD) or median (IQR). Results 11 patients were included, with a mean age of 58.5±9.9 years, 72.7% men. 54.5% were admitted to the ICU and 45.5% to resuscitation, with a stay of 48±26 days and a mortality of 36.4%. The number of comorbidities was 3.1±1.9, highlighting arterial hypertension (63.6%), dyslipidaemia and diabetes mellitus (both 27.3%). All analytical parameters evaluated at admission were altered (IL-6, D-dimer, LDH, CRP and lymphocytes). BMI was 27.6±5.2 kg/m2, with 54.6% of patients with excess weight. Duration of PN was 6±3 days and in 81.8% enteral nutrition was co-administered by nasogastric tube. Estimated total energy expenditure was 2162±244 kcal/day with protein requirements of 117±14 g/day. With artificial nutritional support, 2166±427 kcal/day and 117±18 g protein/day were administered. PN provided 1169±256 kcal, 70±12 g protein, 129±31 g glucose and 39±16 g lipids. The non-protein energy/g nitrogen ratio was 77±14 kcal/g, the glucose:lipid ratio was 61:39±15%, volume was 1152±162 mL and osmolarity was 1425±111 mosmol/L. Regarding micronutrients, sodium (74 (IQR 32) mEq), potassium (59 (IQR 45) mEq), magnesium (10, (IQR 3) mEq), calcium (9 (IQR 0) mEq), chloride (48 (IQR 37) mEq) and phosphorus (12 (IQR 7) mmol) were included, in addition to mixtures of vitamins and trace elements. Conclusion and relevance Artificial nutritional support was the only food source for intubated coronavirus infected patients, so it is essential that it meets nutritional requirements, as in this study, so that it contributes to the recovery of the patient. References and/or acknowledgements Conflict of interest No conflict of interest