How Differences in the Disease Process of the COVID-19 Pandemic Pose Challenges to the Delivery of Critical Care Nutrition.

Journal Article (Journal Article;Review)

PURPOSE OF REVIEW: The COVID-19 pandemic is a unique disease process that has caused unprecedented challenges for intensive care specialists. The hyperinflammatory hypermetabolic nature of the disease and the complexity of its management create barriers to the delivery of nutritional therapy. This review identifies the key differences which characterize this pandemic from other disease processes in critical illness and discusses alternative strategies to enhance success of nutritional support. RECENT FINDINGS: Prolonged hyperinflammation, unlike any previously described pattern of response to injury, causes metabolic perturbations and deterioration of nutritional status. High ventilatory demands, hypercoagulation with the risk of bowel ischemia, and threat of aspiration in patients with little or no pulmonary reserve, thwart initial efforts to provide early enteral nutrition (EN). The obesity paradox is invalidated, tolerance of EN is limited, intensivists are reluctant to add supplemental parenteral nutrition (PN), and efforts to give sufficient nutritional therapy remain a low priority. The nature of the disease and difficulties providing traditional critical care nutrition lead to dramatic deterioration of nutritional status. Institutions should not rely on insufficient gastric feeding alone but focus instead on redoubling efforts to provide postpyloric deep duodenal/jejunal EN or re-examine the role of supplemental PN in this population of patients with such severe critical illness.

Full Text

Duke Authors

Cited Authors

  • Eisa, M; McClave, SA; Suliman, S; Wischmeyer, P

Published Date

  • December 2021

Published In

Volume / Issue

  • 10 / 4

Start / End Page

  • 288 - 299

PubMed ID

  • 34676507

Pubmed Central ID

  • PMC8530202

Electronic International Standard Serial Number (EISSN)

  • 2161-3311

Digital Object Identifier (DOI)

  • 10.1007/s13668-021-00379-9


  • eng

Conference Location

  • United States