COVID 19 Flashcards
When should EN be initiated for the ICU level COVID 19 patient?
Within 24-36 hours of admit to the ICU or within 12 hours of intubation and placement on mechanical ventilation
True or false: majority of patients with sepsis or circulatory shock have been shown to tolerate early EN via a tropic rate
True; unless escalating vasopressors combined with EN intolerance and/or symptoms of ileus, COVID 19 disease w/ shock should not be a contraindication to tropic EN
When should PN be initiated for the high risk COVID patient when gastric feeding is not possible?
As soon as possible; high risk includes those w/ sepsis or shock requiring escalating or multiple vasopressors or when high pressor respiratory support is required
Why is the threshold for switching to PN lower in a COVID patient?
Though bowel ischemia is rare in shock, early PN will subvert concerns for ischemic bowel and reduce droplet aerosol transmission to healthcare providers by avoiding procedures involved in placement and maintenance of an enteral access device
Although exact mechanism of COVID 19 induced GI symptoms are elusive, when present early use of PN should be considered with plans to transition to EN when GI symptoms subside
Placement of any enteral access device may provoke coughing and and should be considered an _____ generating procedure
Aerosol
Which type of feeding tube is preferred for the COVID 19 patient?
Infusion into the stomach via 10-12 Fr feeding NGT; post pyloric tubes should be used only after NGT and prokinetics fail due to more complex placement/monitoring of these tubes.
Continuous rather than bolus feeding is strongly recommended due to reduction in diarrhea and less patient interaction needed
What is an older patient with multiple comorbidities at risk of when starting EN?
Refeeding syndrome; ID’ing pre existing malnutrition and other risk factors for refeeding syndrome is vital
What are the estimated energy and protein needs for a critically ill COVID patient?
Feeding should be initiated w/ low dose EN (hypocaloric or trophic) advancing to full dose EN slowly over first week of critical illness to meet energy goal of 15-20 kcal/kg ABW (70-80% of caloric requirements) and protein goal of 1.2-2.0 gm/kg ABW/day
What type of EN formula is appropriate for use in the patient with COVID 19?
A standard, high protein (>20% protein) plyometric, isosmotic enteral formula should be used in early acute phase of critical illness.
As patients status improves addition of fiber should be considered
In a COVID patient, how should supplemental nutritional modules (protein packets, probiotics, etc) be given?
Once per day in order to cluster care
True or false: a patient requiring prone positioning should be fed enterally?
True; most patients tolerate EN delivered into the stomach while prone but on occasion, post pyloric placement of feeding tube may be considered
True or false: most patients do NOT tolerate early EN within 24 hours of initiating ECMO
False; most patients do tolerate early EN during ECMO; it is recommended to start at low trophic dose w/ slow advancement to goal over the first week
If there is a shortage of enteral feeding pumps, which patients should be given the “priority”
Those requiring small bowel feeding or with symptoms of intolerance; continuous gravity feeding can be attempted for those not able to have a pump
True or false: Acutely ill patients with NGT for gastric decompression may later use the same tube for EN when gastric decompression no longer is needed
True
