Yoğun Bakımda COVID-19 ve Beslenme
Özet
Bu akademik çalışma, COVID-19 hastalarının yoğun bakım ünitelerindeki (YBÜ) beslenme süreçlerini, malnütrisyon risklerini ve tedavi stratejilerini kapsamlı şekilde ele almaktadır. SARS-CoV-2 enfeksiyonu, solunum sistemi başta olmak üzere çoklu organ hasarına, hiperinflamasyona ve hastaların besin alımını engelleyen ağır semptomlara yol açarak malnütrisyon gelişimini hızlandırmaktadır. YBÜ'de uzun süre yatan hastalarda iskelet kası kayıpları ve katabolik süreçler prognozu olumsuz etkilediğinden, NRS-2002 kriterleri ile hızlı bir nütrisyonel risk taraması yapılması hayati önem taşımaktadır. Beslenme tedavisinde, aşırı besleme ve ilişkili hiperkapni riskini önlemek adına hastaların enerji ihtiyaçları ideal olarak dolaylı kalorimetri ile, bu mümkün olmadığında ise ağırlık bazlı denklemlerle (akut fazın erken döneminde hipokalorik, yani hedefin %70'ini aşmayacak şekilde) belirlenmelidir. Protein ihtiyacı kas kütlesini korumak için genellikle günlük 1.3 g/kg düzeyinde hedeflenirken; enteral nütrisyonun (EN) uygulanamadığı veya yetersiz kaldığı durumlarda parenteral nütrisyon (PN) desteği düşünülmelidir. Ayrıca prone pozisyonu, ekstübasyon sonrası disfaji, ECMO ve sürekli renal replasman tedavisi (CRRT) gibi özel klinik durumlarda, hastaya özgü besleme protokollerinin ve yakın takibin sürdürülmesi mortalite ve morbiditeyi azaltmada kritik bir rol oynamaktadır.
This academic study comprehensively examines the nutritional processes, malnutrition risks, and treatment strategies of COVID-19 patients in intensive care units (ICUs). SARS-CoV-2 infection accelerates the development of malnutrition by causing multi-organ damage, hyperinflammation, and severe symptoms that prevent food intake, primarily in the respiratory system. Since skeletal muscle loss and catabolic processes adversely affect the prognosis of patients with long-term ICU stays, conducting a rapid nutritional risk screening using NRS-2002 criteria is of vital importance. In nutritional therapy, to prevent overfeeding and the associated risk of hypercapnia, patients' energy requirements should ideally be determined using indirect calorimetry, or when this is not possible, by weight-based equations (hypocaloric, not exceeding 70% of the target during the early acute phase). While the daily protein requirement is generally targeted at 1.3 g/kg to preserve muscle mass, parenteral nutrition (PN) support should be considered when enteral nutrition (EN) is contraindicated or insufficient. Furthermore, in specific clinical conditions such as prone positioning, post-extubation dysphagia, ECMO, and continuous renal replacement therapy (CRRT), maintaining patient-specific feeding protocols and close monitoring play a critical role in reducing mortality and morbidity.
Referanslar
1.Juan B. Ochoa at all. Lessons Learned in Nutrition Therapy in Patients With Severe COVID-19 jjpen Volume 44, Issue 8 November 2020 Pages 1369-1375https.// doi.org/10.1002/jpen.2005
Rocco Barazzoni at all. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection . clinical nutrition ESPEN Editorial|Volume 39, Issue 6, P1631-1638, JUNE 01, 2020 DOI:https://doi.org/10.1016/j.clnu.2020.03.022
3. DeboraFedele AntonellaDe Francesco SergioRiso AlessandroCollo Obesity, malnutrition, and trace element deficiency in the coronavirus disease (COVID-19) pandemic: An overview Nutrition Volume 81, January 2021, 111016 https://doi.org/10.1016/j.nut.2020.111016
Marcelo M.Rogero at all. Potential benefits and risks of omega-3 fatty acids supplementation to patients with COVID-19 . Free Radical Biology and Medicine Volume 156, 20 August 2020, Pages 190-199 https.//doi.org/10.1016/j.freeradbiomed.2020.07.005
MicheleUmbrello at all. Qualitative and quantitative muscle ultrasound changes in patients with COVID-19–related ARDS Nutrition Volumes 91–92, November–December 2021, 111449 https://doi.org/10.1016/j.nut.2021.111449
Khatiwada, S., Subedi, A. A Mechanistic Link Between Selenium and Coronavirus Disease 2019 (COVID-19). Curr Nutr Rep 10, 125–136 (2021). https://doi.org/10.1007/s13668-021-00354-4
Nicolette J. Wierdsma at all. Poor nutritional status, risk of sarcopenia and nutrition related complaints are prevalent in COVID-19 patients during and after hospital admission . Clinical Nutrition ESPEN Volume 43, P369-376, June 01, 2021 https://doi.org/10.1016/j.clnesp.2021.03.021
Sara Thomas, Celeste Alexander, Bridget A. Cassady Nutrition risk prevalence and nutrition care recommendations for hospitalized and critically-ill patients with COVID-19. Clinical Nutrition ESPEN Volume 44, P38-49, august 01, 2021.https://doi.org/10.1016/j.clnesp.2021.06.002
Robert Martindale at all. Nutrition Therapy in Critically Patients With Coronavirus Disease 2019. JPEN Volume44, Issue7 September 2020 Pages 1174-1184 https://doi.org/10.1002/jpen.1930
Janusz von Renesse at all. Energy requirements of long-term ventilated COVID-19 patients with resolved SARS-CoV-2 infection. Clinical Nutrition ESPEN Volume 44, P211-217, August 01, 2021 DOI:https://doi.org/10.1016/j.clnesp.2021.06.016
Thibault, R., Seguin, P., Tamion, F. ve diğerleri. Yoğun bakım ünitesinde (YBÜ) COVID-19 hastasının beslenmesi: pratik bir rehberlik. Kritik Bakım 24, 447 (2020). https://doi.org/10.1186/s13054-020-03159-z
Thibault, R., Coëffier, M., Joly, F. et al. How the Covid-19 epidemic is challenging our practice in clinical nutrition—feedback from the field. Eur J Clin Nutr 75, 407–416 (2021). https://doi.org/10.1038/s41430-020-00757-6
Emanuele Cereda at all. Early caloric deficit is associated with a higher risk of death in invasive ventilated COVID-19 patients. Clinical Nutrition ESPEN March 01 2021 DOI: https://doi.org/10.1016/j.clnu.2021.02.020
Micic, Dejan, Wall, Elizabeth, Semrad, Carol. Nutrition Support in the ICU-A Refresher in the Era of COVID-19, The American Journal of Gastroenterology: September 2020 - Volume 115 - Issue 9 - p 1367-1370 doi: 10.14309/ajg.0000000000000761
Preiser, JC., Arabi, Y.M., Berger, M.M. et al. A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice. Crit Care 25, 424 (2021). https://doi.org/10.1186/s13054-021-03847-4
Elena Formisano at all.Nutritional therapy for patients with coronavirus disease 2019 (COVID-19): Practical protocol from a single center highly affected by an outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection,Nutrition,Volume 82,2021,111048,ISSN 0899-9007,https://doi.org/10.1016/j.nut.2020.111048.
Rocco Barazzoni at all. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance Clinical Nutrition ESPEN May 10, 2021 DOI:https://doi.org/10.1016/j.clnu.2021.05.006
Wells Mulherin D, Walker R, Holcombe B, et al. ASPEN report on nutrition support practice processes with COVID-19: the first response. Nutr Clin Pract. 2020; 35(5): 783- 791 https://doi.org/10.1002/ncp.10553
Patel JJ, Martindale RG, McClave SA. Relevant Nutrition Therapy in COVID-19 and the Constraints on Its Delivery by a Unique Disease Process. Nutr Clin Pract. 2020;35:792-799. https://doi.org/10.1002/ncp.10566
Aguila EJT, Cua IHY, Fontanilla JAC, et al. Gastrointestinal manifestations of COVID-19: impact on nutrition practices. Nutr Clin Pract. 2020; 35(5): 800- 805. https://doi.org/10.1002/ncp.10554
Lee-anne S. At all. Nutrition guidelines for critically ill adults admitted with COVID-19: Is there consensus? Clinical Nutrition ESPEN Volume 44, P69-77, August 01, 2021 https://doi.org/10.1016/j.clnesp.2021.05.003
Eden T, McAuliffe S .Critical care nutrition and COVID-19: a cause of malnutrition not to be underestimated BMJ Nutrition, Prevention & Health 2021;4:doi: 10.1136/bmjnph-2021-000271
Behrens S. Kozeniecki M. Knapp N. Martindale R.G. Nutrition support during prone positioning: an old technique reawakened by COVID-19. Nutr Clin Pract. 2020; 36: 105-109 https://doi.org/10.1002/ncp.10592
M. Miguélez at all. Nutritional management and clinical outcome of critically ill patients with COVID-19: A retrospective study in a tertiary hospital. Clinical Nutrition ESPEN November 01, 2021 DOI:https://doi.org/10.1016/j.clnu.2021.10.020
Alice Hoyois at all. Nutrition evaluation and management of critically ill patients with COVID-19 during post–intensive care rehabilitation.JPEN Volume45, Issue6 August 2021 Pages 1153-1163 https://doi.org/10.1002/jpen.2101
