Indication and Routes of Nutrition Support 

- Oral feeding is preferred over EN, if possible
- The goal of oral diets and supplements should be a high-calorie and high-protein diet 
- The preferred method of EN is nasogastric tube feeding
- If nasogastric tube feeding fails, nasointestinal feeding is preferred, but due to convenience, PN is often used instead, despite additional potential complications


Smith College

- Nutrition Delivery and Access
- Timing of Nutrition Delivery
- Nutrition in the Prone Position
- The Challenge of GI Intolerance

Innovating Nutrition Practices in the COVID‐19 Pandemic

Aguila, E., Cua, I., Fontanilla, J., Yabut, V., & Causing, M. (2020). Gastrointestinal Manifestations of COVID-19: Impact on Nutrition Practices. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 35(5), 800–805. https://doi.org/10.1002/ncp.10554

Gastrointestinal Manifestations of COVID‐19: Impact on Nutrition Practices

Nutrition Delivery and Access

- For the critically ill patients, EN is advised to be initiated early 
- Low‐dose EN is favoured over the full dose in the first week of critical illness
- During critical illness, the protein goal is set at 1.2–2.0 g/kg ABW/d
- Continuous feeding is recommended over bolus feeding to reduce the incidence of diarrhea, optimize blood glucose levels, and diminish patient-healthcare worker interaction


Timing of Nutrition Delivery


Critically ill patients may require mechanical ventilation, and therefore may require prone positioning. The relatively flat body position, increase in abdominal pressure, and the use of sedative and paralytic agents in high doses on these patients may result in gastric intolerance, making healthcare providers hesitant to feed patients orally. Early EN has been recommended for COVID-19 patients in the prone position.

Nutrition in the Prone Position


GI intolerance, including unexplained abdominal pain, nausea, vomiting, diarrhea, or significant abdominal distention, is common during the early and late acute phases of critical illness.

Countermeasures that can be taken if there is GI intolerance:
- Prokinetics to enhance motility
- If there is delayed gastric emptying, enteral formula should not be concentrated
- Feeding volume or rate can be reduced and formulas with the proper nutrients can also be considered if there is abdominal distension or diarrhea
- If GI intolerance persists, postpyloric feeding can be considered


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