Amid the COVID-19 pandemic, food insecurity among Americans has grown significantly. When malnourished individuals are hospitalized with critical illnesses, many face increased health risks and negative outcomes. Early enteral nutrition can help by maintaining the lean body mass and muscle function that supports the return to mobility.
During a featured session as part of Becker's Healthcare's 11th Annual Meeting in May, sponsored by Abbott Nutrition, experts discussed the clinical and economic ramifications of early enteral nutrition intervention in ICU patients. Speakers included:
- Beth Besecker, MD, director of medical affairs, Abbott Nutrition
- Bridget Cassady, PhD, senior research scientist, Abbott Nutrition
- Kirk Kerr, PhD, senior manager health economist, Abbott Nutrition
Five key takeaways were:
1. Malnourished intensive care unit patients are at higher risk of negative outcomes. Research has found that these individuals are at two times greater risk for ICU readmission and face an eight times increased likelihood of death, according to Dr. Besecker. Many COVID-19-positive ICU patients are either elderly or have comorbid conditions. These populations are at higher risk for malnutrition and skeletal muscle mass loss and strength loss due to persistent hypermetabolism, fever and sedation. "When patients are on noninvasive mechanical ventilation, you may need to start thinking about parenteral nutrition earlier, since these people are often more hypermetabolic and hyperinflammatory," explained Dr. Besecker.
2. Nutrition assessment and monitoring is critical for hospitalized COVID-19 patients. "Nutrition assessment should be an early step in the evaluation of all patients," Dr. Cassidy said. "Several new studies report the prevalence of malnutrition in hospitalized COVID-19 patients based on various diagnostic tools, including the Mini Nutrition Assessment." While early nutrition intervention is often recommended, enteral nutrition may not be appropriate for some patients, especially those with severe GI symptoms. In addition to assessment, ongoing nutrition monitoring is also essential. The medical literature points to the importance of glycemic control in COVID-19 patients, since a high number have quickly developed hypertriglyceridemia.
3. Healthcare experts recommend initiating enteral nutrition early for ICU patients. The Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition suggest starting enteral nutrition within 24 to 48 hours following the onset of critical illness and admission to the ICU, as well as within 12 hours of intubation. In high-risk patients, where early gastric enteral nutrition isn't possible, early parenteral nutrition is a good alternative.
4. Early enteral nutrition can reduce the cost of care. Early enteral nutrition is associated with significant reductions in hospital and ICU lengths of stay, ICU and hospital mortality, and infectious complications. Research has also shown that specialty enteral nutrition diets can reduce costs. "A recent study showed a 38 percent reduction in ICU length of stay for patients with acute respiratory distress syndrome, when fed a specialty enteral nutrition diet. That reduced the cost per case by about $23,000," Dr. Kerr said.
5. Implementing a nutrition strategy requires data, collaboration and standardization. The first step is to analyze your data and practices, followed by building a cross-functional team, standardizing processes, educating staff and cultivating multidisciplinary support.
To find a recording of this session, click here.