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Sun, 31 May 2020

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Why medical foods are vital to the treatment and recovery of Covid-19 patients

Why medical foods are vital to the treatment and recovery of Covid-19 patients

Medical foods provide essential nutrients patients need to recover and thrive, says BSNA | Credit: PA Images

Catherine Hodgson, Public Affairs Manager | British Specialist Nutrition Association (BSNA)

4 min read Member content

Medical foods, whether through continued tube feeds, oral nutritional supplements or dysphagia products, will therefore play a significant role in supporting many patients while in hospital and as they progress through the rehabilitation process and seek to recover from the long term physiological impact of Covid-19.

BSNA members have and continue to play a vital role in supporting the health and wellbeing of patients who have been admitted to hospital with Covid-19.

This comes in the form of providing tube feeds and associated equipment when patients undergo mechanical ventilation in Intensive Care, but also oral nutritional supplements and dysphagia products as patients recover from the trauma of mechanical ventilation and transition back to normal food.

In the weeks since the UK saw its first cases of Covid-19, there has been a growing understanding of the role of intensive care, the wide variety of healthcare professionals involved in caring for patients and the complex treatment for those who are struggling with their breathing (dyspnoea).

Whether patients are put on mechanical ventilators to breathe for them or assisted by ‘Non-invasive ventilation’ (NIV) or ‘Continuous positive airway pressure’ (CPAP) system, there is greater knowledge of the wider care and support that is needed for these patients including their nutrition and hydration needs.

COVID-19 and patients' nutritional status

Poor nutrition is associated with a longer length of hospital stay and increased mortality. Medical foods - or Foods for Special Medical Purposes (FSMPs) – are specially designed to meet the nutritional or dietary needs of patients living with a disease, disorder or medical condition who are temporarily or permanently unable to achieve an adequate nutritional intake from normal foods or through modification of the normal diet. Medical foods provide essential nutrients patients need to recover and thrive.

For Covid-19 patients who are admitted to hospital requiring breathing support, the ability to maintain their nutritional intake is likely to be significantly impacted and for those under sedation. providing naso-gastric tube feeds is therefore essential to avoid malnutrition and dehydration, therefore helping patients recover from the virus.

The Covid-19 pandemic has led to the unprecedented expansion of and challenge to critical care services. This has meant a significant increase in the demand for nutritional support and dietetic care, including the use of medical foods.

Patients who are critically ill are at greater risk of malnutrition and experience severe physiological stress which impacts on their ability to satisfy their nutritional requirements.

While the average time of mechanical ventilation in Covid-19 patients is between 7 and 14 days, these patients are at high nutritional risk. Many patients are being admitted to hospital with symptoms that have already impacted on their nutritional status, such as diarrhoea, abdominal pain and vomiting.

Higher risk co-morbidities for Covid-19 patients such as type 2 diabetes, COPD, or cardiovascular disease, and potential complications of the virus will also mean that proper assessment of the kind of nutritional care they require, including the type of feed product to be used, should be a central part of their treatment planning.

Monitoring of nutrition support is therefore essential during this time given the risk of malnutrition for COVID-19 patients, the increased demand for services and potential reliance on feeding support once patients are moved out of intensive care and eventually discharged from hospital.

Recovery from Covid-19

Ongoing rehabilitation will be essential for many Covid-19 patients moving out of intensive care as they deal with the physical and functional consequences, as well as the psychological impact a prolonged stay in intensive care or a lengthy hospital admission has on patients. These may include swallowing problems (dysphagia), loss of muscle mass due to illness and reduced activity necessitating, in some cases, having to learn to walk again.

There is little information about the health, rehabilitation and social needs of those who survive Covid-19. However, ICU acquired weakness (ICUAW) is well understood and it is likely that many survivors will require long rehabilitation regimes owing to other co-morbidities, old age and extended periods in hospital.

A key element in the rehabilitation process of patients who have been in intensive care is an appropriate assessment of the nutritional support patients may require. As patients seek to rebuild their physical and functional abilities, it will be essential to ensure their nutritional requirements are met which may include increased calorie and protein intakes, combined with physiotherapy.

Medical foods, whether through continued tube feeds, oral nutritional supplements or dysphagia products, will therefore play a significant role in supporting many patients while in hospital and as they progress through the rehabilitation process and seek to recover from the long term physiological impact of Covid-19.

 

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