Barriers to Nutritional Therapy in the Critically Ill Patient with COVID-19 Disease.

Background COVID-19 has created unique challenges for the intensivist, as high ventilatory demands and prolonged hypermetabolism make it difficult to sustain nutritional status. The purpose of this survey was to determine current practices in nutritional therapy and identify barriers to its delivery. Methods A survey questionnaire about delivering nutritional therapy to critically ill patients with COVID-19 disease was sent to clinicians at both academic and community hospitals from September through December 2020. Results Of 440 who viewed the survey link, 198 (45%) completed the questionnaire. Respondents were comprised of 30% physicians and 70% registered dietitians (RD), with 51% representing community programs, 43% academic, and 6% Veterans Affairs Centers. Barely half (49%) had protocols for managing critically ill patients with COVID-19, and only 21% had a protocol for nutritional therapy. While most respondents (83%) attempted to feed by the intragastric route, only 9% indicated that energy/protein needs were met. The biggest barriers to delivery of enteral nutrition (EN) involved the unpredictability of the patient's clinical course, and fear of aspiration in patients with no respiratory reserve. Intensivists were reluctant to add supplemental parental nutrition (PN) due to perceived lack of benefit in the literature. Conclusions The survey results would suggest that strategies for nutritional therapy based on the intragastric infusion of EN have been largely unsuccessful in meeting the energy/protein needs of critically ill patients with COVID-19 disease. It is likely that these barriers exist in providing nutrition to critically ill patients in genetal. Intensivists need to develop protocols which optimally deliver intragastric EN, consider post-pyloric infusion early, and address reluctance to add supplemental PN in the face of deteriorating nutritional status. This article is protected by copyright. All rights reserved.