Nutritional status in patients in a post-COVID-19 Intensive Care Unit Rehabilitation Ward
Keywords:
malnutrition, Nutrition Assessment, Handgrip Strength, rehabilitation, COVID-19Abstract
Background: prolonged stay in the Intensive Care Unit (ICU) is a risk factor for malnutrition. Early nutritional intervention, together with intensive hospital rehabilitation, allows recovery of muscle strength and the achievement or recovery of a normal nutritional status. Objective: to determine the evolution of the nutritional status of post-ICU patients due to COVID-19 in a rehabilitation ward (SaRIP). Methods: descriptive and prospective study that included adult patients admitted to the SaRIP after a prolonged stay in the ICU due to COVID-19. Weight and Body Mass Index (BMI) were assessed at three time points, nutritional status according to Subjective Global Assessment (SGA) and muscle strength at two time points. Mean and standard deviation were calculated and the association between variables was evaluated using the chi-square or Fisher's test or the Wilcoxon test. A significance level of p<0.05 was considered. Results: 42 patients were included, 69,00 % men, with a mean age of 57,20±13 years. According to SGA 88,10 % presented malnutrition at admission and 42,86 % at discharge (p=0,002). The mean BMI at admission to SaRIP was 26,82 ± 5,32 kg/m2 and at discharge 26,99±5,15 kg/m2 (p=0,736). 50,00 % presented weight increase with a mean increase of 2,73 ± 2,07 kg and 100 % increase in grip strength with a mean increase of 3,97±3,64 kg. Conclusions: almost all patients were admitted with malnutrition. Upon discharge, an improvement in nutritional parameters was observed.
Downloads
References
Singhal T. A Review of Coronavirus Disease-2019 (COVID-19). Indian J Pediatr. 2020; 87(4):281-286.doi: 10.1007/s12098-020-03263-6.
Argento FJ, Rodríguez Cairoli F, Perelli L, Augustovski F, Pichón-Riviére A, Bardach A. Parámetros esenciales para utilizar en modelos epidemiológicos de COVID-19 en Argentina: una revisión rápida. Rev Argent Salud Publica. 2021;13(Supl COVID-19):e24.
González-Castro A, Escudero-Acha P, Peñasco Y, Leizaola O, Martínez de Pinillos Sánchez V, García de Lorenzo A. Cuidados intensivos durante la epidemia de coronavirus 2019. Med Intensiva. 2020; 44(6); 351-362. doi: 10.1016/j.medin.2020.03.001.
Burgos PR, Desnutrición y enfermedad. Nutr Hosp. 2013; 6 (1):10-23. ISSN 1888-7961.
Crivelli A, Perman M, Wyszynski D, Alomar F, Bellone M, De Loredo L, et al. Estudio AANEP 99: Prevalencia de desnutrición en hospitales de la Argentina. [Internet]. 2001;10:121-34. [Citado 20 sep 2023]. Disponible en: https://www.researchgate.net/publication/261287437
Gómez-Santa MO, Velázquez-Alva M, Cabrera-Rosales M. Desnutrición en el paciente con COVID-19 y pérdida de masa muscular. Med Int Méx. 2020; 36(Supl 4):S14-S17. doi: 10.24245/mim. v36id.4966.
Li T, Zhang Y, Gong C, Wang J, Liu B, Shi L, et al. Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. Eur J Clin Nutr. 2020; 74(6): 871-875. doi: 10.1038/s41430-020-0642-3.
Bedock, D, Couffignal J, Bel Lassen P, Soares L, Mathian A, Fadlallah JP, et al. Evolution of Nutritional Status after Early Nutritional Management in COVID-19 Hospitalized Patients. Nutrients. 2021; 13(7): 2276. doi:10.3390/nu13072276.
Di Filippo L, De Lorenzo R, D'Amico M, Sofia V, Roveri L, Mele R, et al. COVID-19 is associated with clinically significant weight loss and risk of malnutrition, independent of hospitalisation: A post-hoc analysis of a prospective cohort study. Clin Nutr. 2021; 40(4): 2420-2426. doi: 10.1016/j.clnu.2020.10.043.
Barazzoni R, Bischoff SC, Breda J, Wickramasinghe K, Krznaric Z, Nitzan D, et al. Espen expert statements and practical guidance for nutritional management of individuals SARS-CoV-2 infection. Clin Nutr. 2020; 39(6): 1631-1638. doi: 10.1016/j.clnu.2020.03.022.
Gemelli Against COVID-19 Post-Acute Care Study Group. Post-COVID-19 global health strategies: the need for an interdisciplinary approach. Aging Clin Exp Res. 2020; 32(8): 1613-1620. doi: 10.1007/s40520-020-01616-x.
Imamura M, Mirisola AR, Ribeiro FQ, De Pretto LR, Alfieri FM, Delgado VR, et al. Rehabilitation of patients after COVID-19 recovery: An experience at the Physical and Rehabilitation Medicine Institute and Lucy Montoro Rehabilitation Institute. Clinics (Sao Paulo). 2021; 76:e2804. doi: 10.6061/clinics/2021/e2804.
Gobbi M, Brunani A, Arreghini M, Baccalaro G, Dellepiane D, La Vela. V et al. Nutritional status in post SARS-Cov2 rehabilitation patients. Clin Nutr. 2022; 41(12): 3055-3060. doi: 10.1016/j.clnu.2021.04.013.
Fiorindi C, Campani F, Rasero L, Campani C, Livi L, Giovannoni L, et al. Prevalence of nutritional risk and malnutrition during and after hospitalization for COVID-19 infection: Preliminary results of a single-centre experience. Clin Nutr ESPEN. 2021; 45:351-355. doi: 10.1016/j.clnesp.2021.07.020.
Sousa-Catita D, Godinho C, Mascarenhas P, Quaresma F, Fonseca J. The Effects of an Intensive Rehabilitation Program on the Nutritional and Functional Status of Post-COVID-19 Pneumonia Patients. Nutrients. 2022; 14(12): 2501. doi: 10.3390/nu14122501.
Haraj NE, El Aziz S, Chadli A, Dafir A, Mjabber A, Aissaoui O, et al. Nutritional status assessment in patients with Covid-19 after discharge from the intensive care unit. Clin Nutr ESPEN. 2021; 41: 423-428. doi: 10.1016/j.clnesp.2020.09.214.
Hoyois A, Ballarin A, Thomas J, Lheureux O, Preiser JC, Coppens E, et al. Nutrition evaluation and management of critically ill patients with COVID-19 during post–intensive care rehabilitation. JPEN J Parenter Enteral Nutr. 2021; 45(6):1153-1163. doi: 10.1002/jpen.2101.
Martillo MA, Dangayach NS, Tabacof L, Spielman LA, Dams-O'Connor K, Chan CC,et al. Postintensive Care Syndrome in Survivors of Critical Illness Related to Coronavirus Disease 2019: Cohort Study From a New York City Critical Care Recovery Clinic. Crit Care Med. 2021; 49(9):1427-1438. doi: 10.1097/CCM.0000000000005014.
Haines KJ, Berney S, Warrillow S, Denehy L. Long-term recovery following critical illness in an Australian cohort. J Intensive Care. 2018;6:8. doi:10.1186/s40560-018-0276.
Vickory F, Ridgeway K, Falvey J, Houwer B, Gunlikson J, Payne K, et al. Safety, Feasibility, and Outcomes of Frequent, Long-Duration Rehabilitation in an Inpatient Rehabilitation Facility After Prolonged Hospitalization for Severe COVID-19: An Observational Study. Phys Ther. 2021;101(11):pzab208. doi:10.1093/ptj/pzab208.
Gobierno de la Ciudad de Buenos AIres, Ministerio de Salud. Cómo funcionan las salas de Rehabilitación Intensiva post COVID-19: el caso de Carlos, paciente recuperado. [Internet]. 31 jul 2020. [Citado 20 sep 2023]. Disponible en: ttps://buenosaires.gob.ar/jefedegobierno/noticias/
Canicoba M, de Baptista GA, Visconti G. Funciones y competencias del nutricionista clínico. Documento de consenso de la Federación Latinoamericana de Terapia Nutricional, Nutrición clínica y Metabolismo. RCAN. 2013;23(1):146-172.
Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T. et al. GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Clin Nutr. 2019;38(1):1-9. doi: 10.1016/j.clnu.2018.08.002.
Organización Mundial de la Salud (OMS). Obesity: preventing and managing the global epidemic: report of a WHO consultation on obesity, Geneva, 3-5 June 1997. [Internet]. [Citado 20 sep 2023]. Disponible en: https://iris.who.int/handle/10665/63854
Lipschitz DA. Screening for nutritional status in the elderly. Prim Care. 1994;21 (1):55-67. PMID: 8197257.
Dodds RM, Syddall HE, Cooper R, Benzeval M, Deary IJ, Dennison EM, et al. Grip Strength across the Life Course: Normative Data from Twelve British Studies. PLoS ONE. 2014;9(12): e113637. doi: 10.1371/journal.pone.0113637.
Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status?. JPEN J Parenter Enteral Nutr. 1987;11(1):8-13. doi: 10.1177/014860718701100108.
Nakanishi, N.; Liu, K.; Kawakami, D.; Kawai, Y.; Morisawa, T.; Nishida et al. Post-Intensive Care Syndrome and its New Challenges in Coronavirus Disease 2019 (COVID-19) Pandemic: A Review of Recent Advances and Perspectives. J Clin Med. 2021 10(17):3870. doi: 10.3390/ jcm10173870.
Spruit MA, Holland AE, Singh SJ, Tonia T., WIlson CK, Troosters T. COVID-19: interim guidance on rehabilitation in the hospital and post-hospital phase from a European Respiratory Society- and American Thoracic Society-coordinated international task force. Eur Respir J 2020;56(6):2002197. doi: 10.1183/13993003.02197-2020.
Novak P, Cunder K, Petrovič O, Oblak T, Dular K, Zupanc A, et al. Rehabilitation of COVID-19 patients with respiratory failure and critical illness disease in Slovenia: an observational study. Int J Rehabil Res. 2022;1;45(1):65-71. doi: 10.1097/MRR.0000000000000513.
Woo H, Lee S, Lee HS, Chae HJ, Jung J, Song MJ et al. Comprehensive Rehabilitation in Severely Ill Inpatients With COVID-19: A Cohort Study in a Tertiary Hospital. 2022; 37(34):e262. doi: 10.3346/jkms.2022.37.e262
Cereda E, Clavé P, Collins PF, Holdoway A, Wischmeyer PE. Recovery Focused Nutritional Therapy across the Continuum of Care: Learning from COVID-19. Nutrients. 2021;13(9):3293. doi: 10.3390/nu13093293.
Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601–615. doi:10.1038/s41591-021-01283-z.
Yang J, Hu J, Zhu C. Obesity aggravates COVID-19: A systematic review and meta-analysis. J Med Virol;93(1):257-261. doi: 10.1002/jmv.26237.
Bedock D, Bel Lassen P, Mathian A, Moreau P, Couffignal J, Ciangura C, et al. Prevalence and severity of malnutrition in hospitalized COVID-19 patients. Clin Nutr ESPEN. 2020;40:214-219. doi: 10.1016/j.clnesp.2020.09.018.
Li T, Zhang Y, Gong C, Wang J, Liu B, Shi L, et al. Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. Eur J Clin Nutr. 2020;74(6):871-875. doi: 10.1038/s41430-020-0642-3.
Rives-Lange C, Zimmer A, Merazka A, Carette C, Martins-Bexinga A, Hauw-Berlemont C, et al. Evolution of the nutritional status of COVID-19 critically-ill patients: A prospective observational study from ICU admission to three months after ICU discharge. Clin Nutr. 2022;41(12):3026-3031. doi: 10.1016/j.clnu.2021.05.007.
Brugliera L, Spina A, Castellazzi P, Cimino P, Arcuri P, Negro A, et al. Nutritional management of COVID-19 patients in a rehabilitation unit. Eur J Clin Nutr. 2020;74(6):860-863. doi: 10.1038/s41430-020-0664-x.
Cederholm T. 4 years of the GLIM criteria: Where are we? Results of the GLIM survey. [Internet]. 2023. [Citado 02 oct 2023]. Disponible en: https://www.espen.org/files/glim/GLIMNiceWM2023.pdf
Barazzoni R, Jensen GL, Correia MITD, Gonzalez MC, Higashiguchi T, Shi HP, et al. Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition (GLIM) diagnosis of malnutrition. Clin Nutr. 2022;41(6):1425-1433. doi: 10.1016/j.clnu.2022.02.001.
Correia MITD, Tappenden KA, Malone A, Prado CM, Evans DE, Sauer AC, et al. Utilization and validation of the Global Leadership Initiative on Malnutrition (GLIM): A scoping review. Clin Nutr. 2022;41(3):687-697. doi: 10.1016/j.clnu.2022.01.018.
Pourhassan M, Cederholm T, Trampisch U, Volkert D, Wirth R. Inflammation as a diagnostic criterion in the GLIM definition of malnutrition-what CRP-threshold relates to reduced food intake in older patients with acute disease? Eur J Clin Nutr. 2022;76(3):397-400. doi: 10.1038/s41430-021-00977-4.
Stanojcic M, Finnerty CC, Jeschke MG. Anabolic and anticatabolic agents in critical care. Curr Opin Crit Care. 2016;22(4):325-31. doi: 10.1097/MCC.0000000000000330.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Julieta Adaglio, Luisina del Rio, Mirta Antonini, Romina Sayar
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
