Association between protocol change to a higher‐protein formula with lower energy targets and nutrient delivery in critically ill patients with COVID‐19: A retrospective cohort study
Kym Wittholz, Chloe Hinckfus, Amalia Karahalios, Haustine Panganiban, Nadine Phillips, Hannah Rotherham, Thomas Rechnitzer, Yasmine Ali Abdelhamid, Adam M. Deane, Kate Fetterplace- Nutrition and Dietetics
- Medicine (miscellaneous)
Abstract
Background
Guidelines recommend prioritizing protein provision while avoiding excessive energy delivery to critically ill patients with coronavirus disease 2019 (COVID‐19), but there are no prospective studies evaluating such a targeted approach in this group. We aimed to evaluate the effect of a “higher‐protein formula protocol” on protein, energy, and volume delivery when compared with standard nutrition protocol.
Methods
This was a retrospective cohort study of adult patients with COVID‐19 who received mechanical ventilation for >72 h and enteral nutrition. Before October 2021, the standard nutrition protocol for patients was 0.7 ml/kg/h ideal body weight (IBW) of a 63 g/L protein and 1250 kcal/L formula. From October 2021, we implemented a higher‐protein formula protocol for patients with COVID‐19. The initial prescription was 0.5 ml/kg/h IBW of a 100 g/L protein and 1260 kcal/L formula with greater emphasis on energy targets being directed by indirect calorimetry when possible. Measured outcomes included protein, energy, and volume delivered.
Results
There were 114 participants (standard protocol, 48; higher‐protein protocol, 66) with 1324 days of nutrition support. The median (95% CI) differences in protein, energy, and volume delivery between targeted and standard protocol periods were 0.08 g/kg/day (−0.02 to 0.18 g/kg/day), −1.71 kcal/kg/day (−3.64 to 0.21 kcal/kg/day) and −1.5 ml/kg/day (−2.9 to −0.1 ml/kg/day). Thirty‐three patients (standard protocol, 7; higher‐protein protocol, 26) had 44 indirect calorimetry assessments. There was no difference in measured energy expenditure over time (increased by 0.49 kcal/kg/day [−0.89 to 1.88 kcal/kg/day]).
Conclusion
Implementation of a higher‐protein formula protocol to patients with COVID‐19 modestly reduced volume administration without impacting protein and energy delivery.