There is little practical clinical guidance for nutritional care during recovery of COVID-19, even though it can impact recovery time and people’s ability to return to doing the things that matter most to them. Nutrition is vital for maintaining skeletal muscle and avoiding metabolic disturbances and when patients are spending around two weeks in ICU, these can become very serious issues.

Respiratory difficulties add an extra layer of complexity, preventing patients from eating effectively. A huge proportion of the patients we have treated required assisted ventilation, making it difficult to provide food and oral supplements. This has meant that nutrition has had to become an important part of COVID-19 patients’ recovery.

What is the aim of your research?

My research in Italy is being supported by a grant from Nutricia*. My research aims to better understand the fundamental role of nutritional status and medical nutrition on treatment and recovery outcomes.

I hope the research outcomes will ultimately result in the adoption of practical guidelines on integrating nutritional care in the treatment and rehabilitation of patients.

Why is there a lack of knowledge on appropriate rehabilitation after significant ICU stays, such as those of critically ill COVID-19 patients?

The focus is often on helping patients whether it is through the acute phase of critical illness, for healthcare professionals like myself, as well as the patient and their family, it is a huge relief when they can be discharged.

The long-term impact of their stay in intensive care is sometimes underestimated though, which might impact how well rehabilitation requirements are understood.

What complications are being seen in COVID-19 patients that are leading to long recovery periods?

The care for critically ill COVID 19 patients is similar to that for patients diagnosed with viral pneumonia-causing respiratory failure. What is different though, is that critically ill COVID-19 patients are often admitted to ICUs for a very long time, extending up to 2-3 weeks.

We know from other patient groups in ICUs who require intubation, that oral nutrition intake can be inadequate after extubation. People might not be able to eat enough food to meet their nutritional needs during recovery, contributing to further loss of lean muscle – which could occur in ICU at the rate of up to 1kg per day.

Muscle wasting is the most common complication of critical illness, occurring in up to 50% of patients, which can seriously lengthen recovery times, impaired immunity, increase infection risk and cause the development of wounds and pressure ulcers. For some, even mortality.

In the early days of the pandemic, most of the patients quickly deteriorated, meaning they required immediate respiratory assistance. So, most stopped eating as soon as they were admitted to the hospital and they were also unable to tolerate oral nutrition support.

As the pandemic has progressed, we are increasingly seeing very elderly patients and those suffering from underlying health conditions, like obesity and diabetes.

For these patient groups, nutrition is extremely complex. It is difficult to keep these patients in a stable condition, and what makes the difference in this balance is appropriate and timely nutrition support.

How could appropriate nutrition improve recovery?

Being discharged from the ICU is only the start of a recovery, and medical nutrition when integrated in patient recovery programs can positively impact recovery outcomes, as well as the quality of life of patients. We already know that medical nutrition can positively contribute to clinical outcomes with a variety of conditions and diseases. Unfortunately, healthcare professional awareness of the role of medical nutrition is still low.

There is little practical clinical guidance for nutritional care during recovery of COVID-19, even though it can impact recovery time and people’s ability to return to doing the things that matter most to them. I hope the research will contribute to the development of such guidance.

How could your research be used to provide successful in-hospital rehabilitation programs?

Challenges exist in integrating nutrition into treatment and recovery plans in most diseases. It might seem obvious, but unfortunately, nutrition is still widely overlooked in the hospital setting.

Generally speaking, it is much easier to integrate nutrition into a recovery plan. In the experience of COVID-19, the virus is disproportionately affecting the fragile elderly and those who are overweight or obese with diabetes and hypertension.

For those who have spent a significant length of time in ICU and on ventilators, we can already see the positive results when nutrition is part of both a patient’s treatment and recovery plan.

Media Contact
Mercy
Managing Editor
Journal of Food and Clinical Nutrition