Coronavirus News: Guidelines for Nutrition support of ICU patients

Coronavirus News: Guidelines for Nutrition support of ICU patients

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:

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.

ESPEN will soon publish practical guidance for Nutritional Management of Individuals with CoV-19 infection.  In the meantime, you can access their existing guidance on nutrition in ICU and polymorbid patients here

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, both listed above.

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. 

COVID RESOURCES WEBINAR

IrSPEN are keen to share resources that will be helpful to you as dietitians and HCPs.

COVID-19 WEBINAR LINK: COVID-19: Nutritional Support in the ICU

 Nutricia is conscious that this is a stressful time for you as HCPs and they are doing everything they possibly can to work in partnership with you, to support you to make sure patients continue to get the nutrition support they need. In light of this, Nutricia have a series of webinars coming up on the topic of Covid 19 and specific nutritional requirements and support for your patients to optimally manage this.  Please click here for further details and advice on how to register.

Nutricia has also made a number of other resources available that may be of use around tube feeding and pump use / cleaning for your patients.  Please click here below for our full range of resources.