(451) Starving for Answers: Enteral Feeding Strategies in ICU COVID-19 Patients

Introduction: There are specific considerations for feeding critically-ill COVID + patients, including prone positioning, isolation precautions, hemodynamic instability, gastrointestinal symptoms, and prolonged hypermetabolic state. Enteral nutrition (EN) is delivered volume-based (VB) or rate-based (RB). We hypothesized that COVID + patients receive a reduced percentage of goal enteral intake due to impaired gastric motility, hemodynamic instability, and positional challenges with EN tolerance.

Methods: This single-center retrospective cohort study included adult patients in the intensive care unit between 2020 and 2023. Patients received RB, VB, or mixed EN regimen based on provider judgment. We excluded patients from long term facilities, on EN prior to admission, those on parenteral nutrition, and recent transplants. The primary outcome was COVID status and percentage of goal enteral intake achieved. Secondary outcomes were frequency of each nutrition regimen and percentage of goal enteral intake achieved among COVID+ patients only. Fisher's Exact Test was used for comparisons of categorical data, while ANOVA was employed to analyze overall group differences. P-values for pairwise comparisons were adjusted using the Bonferroni correction to account for multiple comparisons.

Results: A total of 280 patients were included: 180 COVID -, 88 COVID +, 10 were not tested. COVID - patients received 69.43% of their goal enteral intake and COVID + patients received 69.68% (p = 0.884). In the mixed group, 46.25% (37) of the patients were COVID +. For COVID + patients, there was a statistically significant difference comparing those who received mixed vs. VB (p=0.005) but no significance in mixed vs. RB (p=0.068).

Conclusions: COVID + patients were fed an equivalent amount of their energy goal compared to COVID - counterparts. Both groups achieved percentage intake values above the national average of 51%. Additionally, COVID + patients tended to receive a mixed EN regimen. There was no statistically significant difference in percent intake goal among only COVID + patients (VB: 65.42%, RB: 66.90%, Mixed: 74.00%; ANOVA p=0.451). Further investigation into nutrition and nursing protocols with a larger sample size may provide further insight.