Nutrition care processes across hospitalisation in critically ill patients with COVID-19 in Australia: a multicentre prospective observational study

<p><i>Background:</i> The COVID-19 pandemic highlighted major challenges with usual nutrition care processes, leading to reports of malnutrition and nutrition-related issues in these patients.</p> <p><i>Objective:</i> The objective of this study was to desc...

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Bibliographic Details
Main Authors: Ridley, EJ, Chapple, L-AS, Ainscough, K, Burrell, A, Campbell, L, Dux, C, Ferrie, S, Fetterplace, K, Jamei, M, King, V, Neto, AS, Nichol, A, Osland, E, Paul, E, Summers, M, Marshall, AP, Udy, A
Format: Journal article
Language:English
Published: Elsevier 2023
Description
Summary:<p><i>Background:</i> The COVID-19 pandemic highlighted major challenges with usual nutrition care processes, leading to reports of malnutrition and nutrition-related issues in these patients.</p> <p><i>Objective:</i> The objective of this study was to describe nutrition-related service delivery practices across hospitalisation in critically ill patients with COVID-19 admitted to Australian intensive care units (ICUs) in the initial pandemic phase.</p> <p><i>Methods:</i> This was a multicentre (nine site) observational study in Australia, linked with a national registry of critically ill patients with COVID-19. Adult patients with COVID-19 who were discharged to an acute ward following ICU admission were included over a 12-month period. Data are presented as n (%), median (interquartile range [IQR]), and odds ratio (OR [95% confidence interval {CI}]).</p> <p><i>Results:</i> A total of 103 patients were included. Oral nutrition was the most common mode of nutrition (93 [93%]). In the ICU, there were 53 (52%) patients seen by a dietitian (median 4 [2–8] occasions) and malnutrition screening occurred in 51 (50%) patients most commonly with the malnutrition screening tool (50 [98%]). The odds of receiving a higher malnutrition screening tool score increased by 36% for every screening in the ICU (1st to 4th, OR: 1.39 [95% CI: 1.05–1.77] p = 0.018) (indicating increasing risk of malnutrition). On the ward, 51 (50.5%) patients were seen by a dietitian (median time to consult: 44 [22.5–75] hours post ICU discharge). The odds of dietetic consult increased by 39% every week while on the ward (OR: 1.39 [1.03–1.89], p = 0.034). Patients who received mechanical ventilation (MV) were more likely to receive dietetic input than those who never received MV.</p> <p><i>Conclusions:</i> During the initial phases of the COVID-19 pandemic in Australia, approximately half of the patients included were seen by a dietitian. An increased number of malnutrition screens were associated with a higher risk score in the ICU and likelihood of dietetic consult increased if patients received MV and as length of ward stay increased.</p>