Page 26 - Delaware Medical Journal - July/August 2020

An Algorithm for Nutritional Support of Hospitalized Patients with Novel 2019 Coronavirus
Mary Shapero, MS, RD, CNSC, LDN; Michael T. Vest, DO; Tracy Headley, RD, CNSC, LDN; Elisabeth Jones, MS, RD, CNSC, LDN; Theresa Johnston, APRN; Megan Faraj, PharmD; Tep Kang, PharmD; Luis Cardenas, DO, PhD
BACKGROUND
On December 31, 2019, the World Health Organization (WHO) was informed of
an outbreak of an atypical pneumonia in Wuhan, China. This viral pathogen was
acute respiratory syndrome coronavirus 2 (SARS-COV 2) causing coronavirus disease 2019 (COVID-19).1 By January 30, 2020, WHO declared a “public health emergency of international concern” as the virus continued its spread outside of China.1 Since then, the virus has affected a majority of the countries around the world and all 50 states in the United States, including Delaware.
Depending on host-virus interactions, infected persons may be asymptomatic, mildly symptomatic, require hospitalization, or develop critical illness.2 In a report of over 72,000 cases from Wuhan, China, 81% of infected persons had mild symptoms, 14% severe symptoms, and 5% became critically ill.1 Therefore, up to 20% of COVID-19
patients could be at risk of needing hospital care. The COVID-19 pandemic poses unique challenges in ensuring optimal outcomes and decreased mortality in this patient population.
Guidelines for nutrition support of critically ill patients have been issued by the American Society for Parenteral and Enteral Nutrition (ASPEN), the European Society for Clinical Nutrition and Metabolism (ESPEN), and the Society of Critical Care Medicine (SCCM).3,4 For the most part, these can be applied to critically ill COVID-19 patients.5,6 However, in light of rapid disease progression, the
need for cautious initiation of feeding, unclear prior nutritional status, the need to limit exposures and preserve supplies of personal protective equipment (PPE), and admissions, we felt additional guidance was indicated. We developed a feeding algorithm so that physicians, nurse practitioners, and physician assistants could institute early feeding, to help prevent delays in patient
care and thereby preserve nutritional status and prevent or treat malnutrition. This has the potential to reduce complications and negative outcomes in this at-nutritional-risk population.
ALGORITHM DEVELOPMENT
The COVID-19 feeding algorithm was developed by a multidisciplinary team, which included physicians, dietitians, nutrition-support advanced-practice nurses, and pharmacists. One of the main goals of this team was to provide evidence-based guidance to help providers initiate safe, early feeding and medical nutrition therapy for patients during and after hospitalization.
The algorithm assumed that enteral nutrition (EN) was being administered by experienced nurses trained in the administration of enteral feeding and assessment of gastrointestinal tolerance of enteral feeding. This team iteratively created recommendations based on expert opinion, which was continued until
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Del Med J | July/August 2020 | Vol. 92 | No. 4