Effect of early nutrition support on length of stay, mortality, and extubation in patients with COVID-19

Background: Many hospitals have been using nutrition support guidelines for patients with coronavirus disease 2019 (COVID-19) as outlined in the April 2020 article released by the American Society for Parenteral and Enteral Nutrition (ASPEN) and the Society of Critical Care Medicine (SCCM). Currently, there are insufficient data on the outcomes of following these guidelines.

Methods: This was a retrospective, observational study of 131 adult inpatients with COVID-19 admitted to an intensive care unit (ICU) at Banner Health to observe differences in length of stay, mortality, and number of days intubated based on the timing of nutrition support start relative to hours intubated and hours in the ICU.

Results: There were no statistically significant differences between length of stay, mortality, or number of days intubated between patients who started nutrition support within <12 h of intubation, >12 h of intubation and <36 h in the ICU, or >36 h of intubation and those who were not intubated. Patients who started nutrition support after >36 h in the ICU had the longest lengths of stay (median [25th, 75th percentile] = 25.5 [19.25, 35.25] days; P > 0.05) and number of days intubated (16.5 [10.0, 24.75] days; P > 0.050); however, it was not statistically significant. There was a significant difference between the three intubated groups and the nonintubated group on Sequential Organ Failure Assessment scores (P = 0.01).

Conclusions: Prospective, multicenter trials are needed; however, following the SCCM/ASPEN guidelines for nutrition support in patients with COVID-19 may be found to decrease length of stay and number of days intubated.