Nutrition care processes across hospitalisation in critically ill patients with COVID-19 in Australia: A multicentre prospective observational study

Emma J Ridley; Lee-Anne S Chapple; Kate Ainscough; Aidan Burrell; Lewis Campbell; Claire Dux; Suzie Ferrie; Kate Fetterplace; Matin Jamei; Victoria King; Ary Serpa Neto; Alistair Nichol; Emma Osland; Eldho Paul; Matthew Summers; Andrea P Marshall; Andrew Udy

doi:10.1016/j.aucc.2023.01.003

Nutrition care processes across hospitalisation in critically ill patients with COVID-19 in Australia: A multicentre prospective observational study

Aust Crit Care. 2023 Nov;36(6):955-960. doi: 10.1016/j.aucc.2023.01.003. Epub 2023 Jan 17.

Authors

Emma J Ridley¹, Lee-Anne S Chapple², Kate Ainscough³, Aidan Burrell⁴, Lewis Campbell⁵, Claire Dux⁶, Suzie Ferrie⁷, Kate Fetterplace⁸, Matin Jamei⁹, Victoria King¹⁰, Ary Serpa Neto¹⁰, Alistair Nichol¹¹, Emma Osland⁶, Eldho Paul¹⁰, Matthew Summers¹², Andrea P Marshall¹³, Andrew Udy⁴

Affiliations

¹ The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia. Electronic address: emma.ridley@monash.edu.
² Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia.
³ University College Dublin Clinical Research Centre at St Vincents University Hospital, Dublin, Ireland.
⁴ The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia.
⁵ Intensive Care Unit, Royal Darwin Hospital, Darwin, Northern Territory, Australia; Menzies School of Health Research, Darwin, Northern Territory, Australia.
⁶ Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Australia; School of Human Movements and Nutrition Science, University of Queensland, Brisbane, Australia.
⁷ Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; School of Medicine and Health, University of Sydney, New South Wales, Australia.
⁸ Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Victoria, Australia; The University of Melbourne, Department of Critical Care, Melbourne Medical School, Melbourne, Victoria, Australia.
⁹ Intensive Care Unit, Nepean Hospital, Sydney, New South Wales, Australia.
¹⁰ The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
¹¹ The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; University College Dublin Clinical Research Centre at St Vincents University Hospital, Dublin, Ireland; Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia.
¹² Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
¹³ Intensive Care Unit, Gold Coast University Hospital, Southport, Queensland, Australia; Menzies Health Institute, Griffith University, Southport, Queensland, Australia.

Abstract

Background: The COVID-19 pandemic highlighted major challenges with usual nutrition care processes, leading to reports of malnutrition and nutrition-related issues in these patients.

Objective: The objective of this study was to describe nutrition-related service delivery practices across hospitalisation in critically ill patients with COVID-19 admitted to Australian intensive care units (ICUs) in the initial pandemic phase.

Methods: This was a multicentre (nine site) observational study in Australia, linked with a national registry of critically ill patients with COVID-19. Adult patients with COVID-19 who were discharged to an acute ward following ICU admission were included over a 12-month period. Data are presented as n (%), median (interquartile range [IQR]), and odds ratio (OR [95% confidence interval {CI}]).

Results: A total of 103 patients were included. Oral nutrition was the most common mode of nutrition (93 [93%]). In the ICU, there were 53 (52%) patients seen by a dietitian (median 4 [2-8] occasions) and malnutrition screening occurred in 51 (50%) patients most commonly with the malnutrition screening tool (50 [98%]). The odds of receiving a higher malnutrition screening tool score increased by 36% for every screening in the ICU (1st to 4th, OR: 1.39 [95% CI: 1.05-1.77] p = 0.018) (indicating increasing risk of malnutrition). On the ward, 51 (50.5%) patients were seen by a dietitian (median time to consult: 44 [22.5-75] hours post ICU discharge). The odds of dietetic consult increased by 39% every week while on the ward (OR: 1.39 [1.03-1.89], p = 0.034). Patients who received mechanical ventilation (MV) were more likely to receive dietetic input than those who never received MV.

Conclusions: During the initial phases of the COVID-19 pandemic in Australia, approximately half of the patients included were seen by a dietitian. An increased number of malnutrition screens were associated with a higher risk score in the ICU and likelihood of dietetic consult increased if patients received MV and as length of ward stay increased.

Keywords: COVID-19; Critical illness; Intensive care; Malnutrition; Nutrition.

Publication types

Observational Study
Multicenter Study

MeSH terms

Adult
Australia / epidemiology
COVID-19*
Critical Illness
Hospitalization
Humans
Intensive Care Units
Malnutrition* / diagnosis
Malnutrition* / epidemiology
Pandemics