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) Scotland), 2022-12, Vol.41 (12), p.3069-3076
Main Authors: Liu, Rebecca, Paz, Mary, Siraj, Layla, Boyd, Taylor, Salamone, Silvia, Lite, Thúy-Lan Võ, Leung, Krystle M., Chirinos, Josue D., Shang, Helen H., Townsend, Matthew J., Rho, Junsung, Ni, Peiyun, Ranganath, Kushi, Violante, April D., Zhao, Zezhou, Silvernale, Casey, Ahmad, Imama, Krasnow, Nira A., Barnett, Erica S., Harisinghani, Mukesh, Kuo, Braden, Black, Katharine E., Staller, Kyle
Format: Article
Language:English
Subjects:
Adult
COVID-19 - complications
COVID-19 - epidemiology
COVID-19 - therapy
Critical Illness - therapy
Enteral Nutrition - adverse effects
Feeding intolerance
GI dysmotility
Hospital Mortality
Humans
ICU
Infant, Newborn
Intensive Care Units
Malnutrition
SARS-CoV-2
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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 
ISSN:0261-5614
1532-1983
DOI:10.1016/j.clnu.2021.03.033