12 May 2020
The practical considerations contained in this document are intended for use during the response to the coronavirus pandemic and may not be considered optimal outside of the pandemic. The pragmatic approaches outlined are intended to complement local protocols for nutritional care that may need to be adapted for use at this time. How challenges to providing nutritional care can be met will differ depending on local surge, availability and organisation of resources such as staff, skill mix and personal protective equipment (PPE).
Most patients admitted to hospital with COVID-19 disease present with severe inflammation and disease-related anorexia leading to a major reduction in food intake.1 Some of these patients may have experienced symptoms at home for several days prior to admission.
Immunocompromised patients, older people, individuals with polymorbidity and malnourished individuals appear to have the worst outcomes and higher mortality from COVID-19 disease.2
Prevention, diagnosis and treatment of malnutrition should be routinely included in the management of COVID-19 patients both in hospital and after discharge.2 Appropriate nutritional assessment and treatment reduces complications and improves clinical outcomes in hospitalised patients.2
Some patients will require treatment in the intensive care unit (ICU). Refer to guidance developed by the British Dietetic Association (BDA) Critical Care Specialist Group (CCSG) for ICU patients; Guidance on the management of nutrition and dietetic services during the COVID-19 pandemic, COVID-19 Best Practice Guidance: Enteral Feeding in Prone Position, Best Practice Guidance: Bolus Enteral Feeding and Nutritional recovery and rehabilitation after critical illness.
Not all patients admitted to hospital with confirmed COVID-19 disease will receive critical care input but many may either require prolonged admission in an acute ward with likely respiratory support, or have accelerated care through an early supported discharge pathway. Providing optimal nutrition support and hydration plays a vital role in the recovery and rehabilitation of all these patient groups.
The aim of this document is to provide practical considerations for the nutritional management of non-ICU COVID-19 patients in hospital. As COVID-19 is a new disease, limited data are available to produce evidence-based guidance for this patient group at this time. Therefore, this document has been developed using recently published international guidance on the nutritional management of patients with COVID-192,3, evidence for the nutritional management of other respiratory conditions such as chronic obstructive pulmonary disease4 and clinical experience. It aims to outline some practical considerations and signpost other relevant resources relating to nutrition support, developed in response to the pandemic, to facilitate good clinical practice and continuity of care.