Implementation of a multidisciplinary nutritional support team and clinical outcomes in critically ill patients with COVID-19

In-Ae Song; Kyunghwa Lee; Sunghee Lee; Keonhee Kim; Tak Kyu Oh

doi:10.1016/j.clnu.2023.12.007

Implementation of a multidisciplinary nutritional support team and clinical outcomes in critically ill patients with COVID-19

Clin Nutr. 2024 Feb;43(2):315-321. doi: 10.1016/j.clnu.2023.12.007. Epub 2023 Dec 12.

Authors

In-Ae Song¹, Kyunghwa Lee², Sunghee Lee², Keonhee Kim², Tak Kyu Oh³

Affiliations

¹ Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, South Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, South Korea.
² Department of Pharmacy, Seoul National University Bundang Hospital, South Korea.
³ Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, South Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, South Korea. Electronic address: airohtak@hotmail.com.

PMID: 38142476
DOI: 10.1016/j.clnu.2023.12.007

Abstract

Background & aims: The South Korean government established the multidisciplinary nutritional support teams (NST) system for enhancing the evaluation and adequate supply of nutritional support to patients at high risk of malnutrition. However, the impact of the NST on clinical outcomes in critically ill patients with coronavirus disease 2019 (COVID-19) remains unclear. We aimed to investigate whether NST implementation affects survival outcomes in patients with COVID-19 requiring intensive care unit (ICU) admission.

Methods: Using data from the National Health Insurance Service and Korea Disease Control and Prevention Agency in South Korea, adult patients with COVID-19 admitted to the ICU between October 8, 2020, and December 31, 2021, were included. The NST comprised four professional personnel (physicians, full-time nurses, full-time pharmacists, and full-time clinical dietitians). Patients admitted to ICUs with and without the NST system were assigned to the NST and non-NST groups, respectively.

Results: A total of 13,103 critically ill adult patients were included in the final analysis; among them, 10,103 (77.1 %) and 3,000 (22.9 %) patients were included in the NST and non-NST groups, respectively. In the NST group, 2,803 (27.7 %) critically ill patients with COVID-19 were prescribed enteral or parenteral nutrition by the NST. In a covariate-adjusted multivariable model, the NST group showed a 40 % lower in-hospital mortality rate than the non-NST group (odds ratio: 0.60, 95 % confidence interval: 0.51, 0.71; P < 0.001). In subgroup analyses, compared with the non-NST group, the NST group showed significantly lower in-hospital mortality rates at 2, 3, 4, and 5 points on the World Health Organization clinical progression scale among patients with acute respiratory distress and mechanical ventilatory support.

Conclusions: NST implementation was associated with improved survival outcomes in critically ill patients with COVID-19; accordingly, it may be recommended for improving adequate nutritional support and evaluation in critically ill patients.

Keywords: COVID-19; Malnutrition; Multidisciplinary nutritional support.

MeSH terms

Adult
COVID-19* / therapy
Critical Illness / therapy
Enteral Nutrition*
Humans
Intensive Care Units
Nutritional Support
Parenteral Nutrition