Coronavirus News: Guidelines for Nutrition support of COVID-19 patients

Coronavirus News: Guidelines for Nutrition support of COVID-19 patients

NEW DOCUMENTS AVAILABLE

Many patients with suspected or confirmed COVID-19 admitted to ICU will require artificial nutrition support. 

To provide help to those dealing with ventilated patients who need feeding, newly developed Guidelines for feeding patients admitted to ICU are being released in draft form and may be accessed here. These have been developed by a sub group of ICU dietitians for the HSE Critical Care Programme, with input from Speech and Language Therapy and Pharmacy.  Updates to the document may be made over the coming days/weeks so please check online to ensure you have the latest edition.

Note: These out of hours guidelines are designed primarily for use by doctors and healthcare professionals other than dietitians, where access to a dietitian is not immediately but will be helpful to dietitians that are new to ICU and may be assisting with ICU/HDU cover in the coming weeks.

For ventilated COVID patients who require feeding, it is important to note that such patients may be fluid limited, they may be proned early and for a prolonged time, and may be more at risk of refeeding syndrome and at higher risk of developing diarrhoea.  Whereas most will be suitable candidates for enteral nutrition (EN), some will require parenteral nutrition (PN). It is therefore essential to consult local out of hours PPPGs, or if not available, use the Critical Care Programme draft algorithm and evidence outline to support decision making.

If you are a dietitian and keen to access more specific COVID feeding templates and guidelines, INDI has created a resource hub which contains more COVID specific feeding templates for dietitians and will be made available via open access, not just INDI members.  All materials are being actively developed and updated. The link to the INDI website can be accessed here.

Thanks to the many dietitians who have been involved in developing and sharing their expert guidelines and resources, all of whom are working hard to ensure that patients receive ‘best-practice’ nutritional care.

Additional resources that may be of help and which will be added to over the coming days/weeks:

WHO Academy COVID-19 learning app:

The WHO Academy’s new COVID-19 mobile learning app is targeted specifically to health workers. While WHO has not yet made a formal announcement, we want you to be able to download it now and share with your colleagues and with health workers globally. 

With content in six languages, the app delivers mobile access to a wealth of COVID-19 knowledge resources developed by WHO, including up-to-the-minute guidance, tools, training, and virtual workshops to support health workers in caring for patients infected by COVID-19 and protect themselves as they do their critical work.

The app was created in direct response to an online survey of health works conducted by the WHO Academy in March and April, to which we received more than 20,000 responses.  It provides detailed information and tools addressing key areas of concerns for health workers responding to the outbreak:

  • Infection prevention control
  • Case management
  • Use of personal protective equipment
  • Staff safety and health
  • Risk communication & community engagement

Please download the app, try it out and let us know what you think.  It is available in the Apple App Store and the Google Play store https://play.google.com/store/apps/details?id=org.who.WHOA.

HSE Covid-19 Clinical Guidance and Evidence

NEW:  ESPEN EXPERT STATEMENTS AND PRACTICAL GUIDANCE FOR NUTRITIONAL MANAGEMENT OF INDIVIDUALS WITH SARS-cov-2 INFECTION

Summary:  Nutrition intervention and therapy needs to be considered as an integral part of the approach to patients victim of SARS-CoV-2 infection in the ICU setting, internal medicine ward setting as well as in general healthcare. A comprehensive approach associating nutrition to life-support measures has potential to improve outcomes particularly in the recovery phase.  This paper provides ten recommendations for managing nutritional care in COVID-19 patients. They highlight the importance of nutritional therapy being an integral component of patient care at each stage of treatment. Optimal outcome can be improved by implementing adherence to recommendations to ensure survival of this life threatening disease as well as better and shorter recovery, particularly but not limited to the post-ICU period.

Please note that ESPEN ICU guidelines are referenced and used in the development of the draft Critical Care Programme Intensive Care Nutrition Support Algorithm and the Summary of Clinical Practice Guidelines on Nutrition Support in ICU.

ICU Nutrition Guidelines and tutorials

 This algorithm has been released in draft form to provide important guidance on ICU nutrition to MDT members, including dietitians new to ICU, for patients admitted to ICU out of hours / where access to a specialist ICU dietitian is not immediately available.  Updates will be made but this site will ensure that the document accessed here is the latest available.

This document is an excellent resource prepared by ICU Dietitian  Lisa Shanahan and dietitians in the Mater Hospital.  Providing an at-a-glance summary of international Clinical Practice Guidelines, this would be very useful for the MDT members.

Specialist dietitians Lisa Shanahan, Jenny Caffrey, Aine Kelly and Carmel O’Hanlon address the most common questions that arise in feeding ICU patients, such as the nutritional requirements through different phases of critical illness, requirements of obese patients, refeeding syndrome and when to use enteral vs parenteral nutrition.

This includes relevant medical and nursing information.  However, for nutrition information, refer to the CCP draft guidelines already listed.

Guidance and resources for dietitians

For the most complete range of resources and information for dietitians, refer to the INDI website, which has kindly made all documents available on open access (for non members as well as members) (click here)

Other guidelines that may be important sources of specific information:

The Surviving Sepsis Campaign 2016 Guidelines are being adopted as ‘Sepsis Management’ guidelines in Ireland through the NCEC guideline development process. Relevant nutritional questions are answered and related evidence is presented on the nutritional management of patients with severe sepsis and septic shock in the intensive care setting.

The National institute for Clinical Health and Excellence (NICE) has uploaded a COVID-19 rapid guideline on Critical Care in adults, which has useful medical and nursing resources for reference. The Faculty of Intensive Care Medicine (FICM)

GPICS document (UK) is a useful resource for medical and nursing staff and has relevant nutrition sections on pages 53, 129 and 134.