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Stay home. Protect the NHS. Save lives. This is the current advice from the Government in order to slow the spread of COVID-19. Limiting movement is great but this also limits the ability to buy groceries and is likely going to have a knock-on effect on our meal habits during this time. We will discuss this in another post, but in this one I want to talk about something that not many people know about. The important role dietitians play in working alongside other health professionals in caring for patients with COVID-19.

Dietitians are identified as key workers when it comes to the coronavirus pandemic, and are essential for ensuring patients receive adequate nutrition and hydration during their treatment.  Part of the patient’s treatment may also involve being placed in a critical care unit, where a ventilator can be used to support the patients breathing. Simply put, ventilators take over the body’s breathing process when the lungs are damaged. For patients requiring mechanical ventilation, this presents somewhat of a nutritional challenge. Even in those patients with non-invasive ventilators, having to wear a face mask supplying oxygen can really hamper eating. Visiting is also reduced and there is likely less contact between patients and members of staff. All of this means less food is eaten, and in those requiring nutrition support, an enteral feeding tube may be required. This is complicated further by additional comorbidities (one or more additional conditions) that a lot of patients with COVID-19 have, including diabetes, COPD, hypertension, and asthma. This is where the dietitians come in. 

One thing you will hear on placement is nutrition support. Nutrition support involves people receiving nutrition by mouth (i.e. food and/or supplements) or through a tube. Tube feeding delivers nutrition direct to the gut, and is commonly seen in patients who have had a stroke or other neurological conditions, or after certain operations or treatments (such as surgery or radiotherapy to the throat). Sometimes people are fed directly into their blood stream. This is called parenteral nutrition.

For those patients with COVID-19 who are very poorly and need to be ventilated, tube feeding is a necessity. The British Dietetic Association has produced specialist guidance on this. The common route for patients with COVID-19 is nasogastric feeding (NG, a tube that goes up the nose, down the back of the throat and into the stomach) although there are some exceptions. In this scenario, dietitians have an important role in assessing the patients’ nutritional requirements (including energy and protein) and ensuring that appropriate feeds are prescribed. There are a variety of feeds available which vary in energy, protein, fibre and sodium to name a few nutrients, and dietitians working with these patients must look at this alongside the additional medical aspects, such as drugs. It is crucial that dietitians work closely with other healthcare professionals, so good, clear communication skills are vital.

For example, a lot of critically ill patients will be sedated using a drug called propofol. This is a lipid solution which contains roughly 1.1 kcal/ml which when infused continuously can add up to a lot of extra calories. There will also be use of drugs called prokinetics, which work by enhancing gastrointestinal motility and allow the contents of the stomach to empty faster. This is important especially if patients are placed in the prone position (a position in which the person lies flat with the chest down and the back up) with an NG in place. Patients may also require volume restrictions to help manage respiratory symptoms which might mean they require more concentrated, energy dense feeds (denser feeds contain less fluid). However, these types of feed can also lead to gastrointestinal upset, so monitoring is vital to avoid such complications.

It is safe to say that there is a lot that goes in to looking after these really complex patients, and it is important that dietitians working in this area have excellent skills in communication, pharmacology, and respiratory physiology. Dietitians play a vital role in preserving patients’ nutritional status during their hospital stay and will likely have a key role in helping these patients rehabilitate once discharged. 

Remember: Stay home. Protect the NHS. Save lives.

Here are a couple of websites with more information:

British Dietetic Association Critical Care Group COVID-19 Guidance

Find out more about enteral nutrition

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