- 139 critically ill COVID-19 patients required medical nutrition treatment at a university hospital in Spain. Estimated caloric and protein requirements were 1773±252 kcal and 91.7±17 g per day. - Most patients (82.7%) required invasive mechanical ventilation. Parenteral nutrition was started before enteral nutrition, on average days 2.5±2.6 and 6±4.9 after admission respectively. - Only around one third of patients received caloric and protein requirements according to ESPEN guidelines of 70% estimated calories by day 4 and 100% estimated protein progressively in the first week. Adherence was lower for both calories and protein.

1. XXX Seminario de Nutrición Clínica
Dr. Abraham García Almansa
COVID-19: aspectos nutricionales
Dr. Jose Eugenio Guerrero Sanz
Jefe de Servicio de Medicina Intensiva
Hospital General Universitario Gregorio Marañón. Madrid
26 de octubre 2020

2. https://www.comunidad.madrid/servicios/salud/2019-nuevo-coronavirus

3. Paciente
Desnutrición
SarcopeniaDisfagia
↓ act. física Inflamación
↓ ingesta

4. Tratamiento nutricional en planta:
Energía 27-30 kcal/kg/día, proteínas > 1 g/kg/día
añadir SNO si no se cubren requerimientos, al menos 400 kcal y 30 g de proteínas
Tratamiento nutricional en UCI: Energía: 25 kcal/kg/día, Proteínas: 1.3 g/kd/día
Empezar de forma progresiva hasta alcanzar 70-100% requerimientos a partir del 4º-7º día
VMNI/CNAF VMI Postintubation
Offer
• Dieta oral y SNO
• Añadir NP si se precisa
(periférica o central)
Start
• Comenzar NE (48 h), progresar
según tolerancia (incluido en prono)
• Añadir NP después del 3º-5º día si
se precisa
Offer
• Cribado de disfagia
• Dieta de textura modificada
• Mantener la NE si es preciso
Barazzoni R, et al. ESPEN expert statements and practical guidance for nutritional management of individuals with Sars-Cov-2 infection, Clinical Nutrition, https://doi.org/10.1016/j.clnu.2020.03.022.

5. • Dietas con alto contenido energético y proteínas
• Distribución de SNO a todas las plantas de
hospitalización COVID
• Nutrición enteral (disfagia y/o baja ingesta con dieta y
SNO (< 75% req.)
• Nutrición parenteral (si existe contraindicación de vía
oral/enteral y/o como complementaria a la dieta
oral/SNO)
• Aislamiento
Gomes F, et al. ESPEN guideline on nutritional support for polymorbid internal medicine patients. Clin Nutr 2018;37:336-353
Barazzoni R, et al. Clinical Nutrition, https://doi.org/10.1016/j.clnu.2020.03.022. Caccialanza R, et al. Nutrition 74 (2020) 110835.
Plantas COVID

6. Nutritional treatment in critically ill patients with COVID-19 disease: Spanish experience in a university hospital
C. Cuerda 1, 2, *, C. Velasco 1, 2, M. Miguélez 1, 2, R. Romero2, 3, P. Carrasco 1, 2, C. Serrano1, 2 , I. Bretón 1, 2, M. Motilla 1, 2,L. Arhip 1, 2, Á. Morales 1, 2, M. Carrascal1, 2, S. Rubio 1, 2,
C. Calvo 1, 2, M. Camblor 1, 2
1 Nutrition Unit. 2 Instituto de Investigación Sanitaria Gregorio Marañón. 3 Servicio de Farmacia. Hospital General Universitario Gregorio Marañón. Madrid. Spain, * cuerda.cristina@gmail.com
Forty-nine patientswere included (78% men), 63.1±11.8 years, BMI
29.1±5.1 kg/m2. Figure 1 shows the comorbidities presented by the
patients.
98% of the patients required mechanicalventilation (98% pronation).
The time from hospitalisation to ICU admission was 3.2±3.4 days.
71% of the patients received EN, 98% PN and 69% mixed EN+PN.
The caloric and protein requirements were: 1747±201 kcal and 91.7±10 g.
Table 1 presentstotal and % of caloric and protein goal at day 4th and
7th.
During the first week:
• 59.2% and 10.2% patientshad low levels of P and Mg, respectively
• 81.6% hyperglycaemia
• 8.2% hypoglycaemia
• 95% hypertriglyceridemia(23%>500 mg/dl)
• 34.7% AKF and 16.3% KRT
• 49% mortality
Patients with COVID-19 disease develop respiratoryinsufficiency, 5% of
which needs ICU treatment. Describe the experience of a tertiary
hospital in the nutrition treatment, during this pandemic and the
adherenceto clinical guidelines.
Retrospectivestudy including COVID-19 patients from 3 ICU units of our
hospital that needed medical nutrition treatment (MNT). The variables
that were collected were: sex, age, BMI, underlyingdiseases, time from
hospitalisation to ICU admission, type of respiratorysupport, caloric
and protein requirements(25 kcal/kg adjusted body weight (ABW), 1.3
g/kg ABW/day), MNT type (enteral nutrition (EN), parenteral nutrition
(PN), mixed EN+PN), total calories (including propofol) and proteins
administered,percentageof caloric and protein goal in ICU day 4th and
7th, metabolic complications,acute kidney failure (AKF), mortality.
Variables are expressed as percentages and mean+SD.
Statistics were performed with the programmeIBM-SPSS26v.
 Most of our patients reached estimated caloric
and protein target at day 4th and 7th of ICU.
 PN was necessary in most of our sample in the first
week to reach nutritionalrequirements.
 We observed a high rate of metabolic
complications which requires close monitoring of
nutritional treatment.
Poster of distinction
ESPEN congress
September 2020
Unidad de Nutrición
Clínica y Dietética
Table 1. Calories (kcal)
% caloric goal
Protein (g)
% protein goal
% patients >70%
caloric goal
% patients >70%
protein goal
ICU:4th day 1520±471
88.3±28.7
74.4±23.4
82.4±28.2
83% 72.3%
ICU:7th day 1609±450
93.1±26.8
81.9±24.1
90±27.4
89.9% 89.9%
53
28,5
61,2
49
20,4
0
10
20
30
40
50
60
70
Overweight Obesity Hypertension Dyslipidaemia Diabetes
FIGURE 1. COMORBIDITIES
Rationale and Aims
Methods
Results Conclusions

7. Nutritional treatment in critically ill patients with COVID-19 disease: Spanish experience in a university
hospital (extended)
C. Cuerda 1, 2, *, C. Velasco 1, 2, M. Miguélez 1, 2, M. Carrascal1, 2, R. Romero2, 3, P. Carrasco 1, 2, C. Serrano1, 2 , I. Bretón 1, 2, M. Motilla 1, 2,L. Arhip 1, 2, Á. Morales 1, 2, S. Rubio 1, 2,
C. Calvo 1, 2, J. Wong 1, M. Camblor 1, 2
1 Nutrition Unit. 2 Instituto de Investigación Sanitaria Gregorio Marañón. 3 Servicio de Farmacia. Hospital General Universitario Gregorio Marañón. Madrid. Spain, * cuerda.cristina@gmail.com
The study included 139 patients(74.8% men), 59.6±13.8 years, BMI
29.9±5.3 kg/m2. Figure 1 shows the comorbidities presented by the
patients.
82.7% of the patients required invasive mechanical ventilation
(pronationin 90.4% of them), 3.6% ECMO.
The time from hospitalisation to ICU admission was 3.3±4.3 days.
12.2% of the patientsreceived EN, 29.5% PN and 51.8% mixed
EN+PN.
The caloric and protein requirements were 1773±252 kcal and
91.7±17 g. Table 1 presentstotal calories and proteins
administered at day 4th and 7th.
During the first week:
• 61.9% and 8.6% patients had low levels of P and Mg,
respectively
• 74.1% hyperglycaemia
• 7.9% hypoglycaemia
• 70.5% hypertriglyceridemia(23.5% >500 mg/dl)
• 25.9% AKF and 10.8% KRT
• 31.7% mortality
ICU length of stay was 21.8±15.7 days.
Currently, 5 patientsare still in ICU.
Patients with COVID-19 disease develop respiratoryinsufficiency, 5% of
which needs ICU treatment. The aims of this study was to describe the
experience of a tertiary hospitalin the nutrition treatment during this
pandemic.
Retrospectivestudy including COVID-19 patients from 5 ICU units of our
hospital that needed medical nutrition treatment (MNT).
The collected variables were: sex, age, BMI, underlying diseases, time
from hospitalisationto ICU admission, type of respiratorysupport,
caloric and protein requirements(25 kcal/kg adjusted body weight
(ABW), 1.3 g/kg ABW/day), MNT type (enteral nutrition (EN), parenteral
nutrition (PN), mixed EN+PN), total calories (including propofol) and
proteins administered, metabolic complications,kidney failure,
mortality.
Variables are expressed as percentages and mean+SD.
Statistics were performed with the programmeIBM-SPSS26v.
References
1. Singer P. et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr.
2019;38(1):48-79.doi: 10.1016/j.clnu.2018.08.037.
Conclusions
 Most of our patients reached estimated caloric
and protein target at day 4th and 7th of ICU.
 PN was necessary in most of our sample in the
first week to reach nutritional requirements.
 We observed a high rate of metabolic
complications that requires close monitoring of
nutritional treatment.
Unidad de Nutrición
Clínica y Dietética
Table 1. Calories (kcal) Protein (g)
ICU:4th day 1282±614 60±31
ICU:7th day 1351±688 67.8±37
52,3
38,6
47,5 43,9
18,7
0
10
20
30
40
50
60
FIGURE 1. COMORBIDITIES
Methods
Background and aims Results
ESPEN congress
September2020

8. Nutritional treatment in critically ill patients with COVID-19 disease: from guidelines to clinical practice
C. Cuerda 1, 2, *, C. Velasco 1, 2, M. Miguélez 1, 2, R. Romero2, 3, P. Carrasco 1, 2, C. Serrano1, 2 , I. Bretón 1, 2, M. Motilla 1, 2,L. Arhip 1, 2, Á. Morales 1, 2, M. Carrascal1, 2, S. Rubio 1, 2,
C. Calvo 1, 2, M. Camblor 1, 2
1 Nutrition Unit. 2 Instituto de Investigación Sanitaria Gregorio Marañón. 3 Servicio de Farmacia. Hospital General Universitario Gregorio Marañón. Madrid. Spain, * cuerda.cristina@gmail.com
One hundred and thirty-nine patients were included (74.8% men),
59.6±13.8 years, BMI 29.9±5.3 kg/m2. Figure 1 shows the
comorbidities presented by the patients.
82.7% of the patients required invasive mechanical ventilation
(90.4% of them with pronation), 3.6% ECMO.
Estimated caloric and protein requirements: 1773±252 kcal and
91.7±17 g.
Table 1 presents delivered and % of delivered/estimated caloric
and protein goal at day 4th and 7th, and adherence to ESPEN
guidelines.
PN was started at day 2.5±2.6 and EN at day 6±4.9 of admission
(delayed in patients who needed pronation p<0.05).
Only 16.6 % of patients started EN in the 48h, and 38.5% started
PN in the 3rd-7th day of admission.
Describe the experience of a tertiary hospital in the nutrition treatment
and the adherenceto clinical guidelines during the COVID-19 pandemic.
Retrospective study including critically ill COVID-19 patients of our
hospital who needed medical nutrition treatment (MNT).
We collected the following variables: sex, age, BMI, underlying diseases,
type of respiratory support, caloric and protein requirements (25 kcal/kg
adjusted body weight (ABW), 1.3 g/kg ABW/day), total calories
(including propofol) and proteins administered at day 4th and 7th of ICU
admission, percentage of estimated calories and protein delivered at day
4th and 7th, day of starting enteral nutrition (EN) and parenteral nutrition
(PN).
The adherence to ESPEN clinical guidelines (70% of estimated calories at
day 4th and 7th, 100% estimated protein progressively in the first week,
start EN in the 48h and PN in 3rd-7th day ICU admission).
Variables are expressed as percentages and mean+SD.
Statistics were performed with the programmeIBM-SPSS26v.
References
1. Singer P. et al. ESPEN guideline on clinical nutrition in the intensive care unit.
Clin Nutr. 2019;38(1):48-79.doi: 10.1016/j.clnu.2018.08.037.
 Only around one third of our patients received
caloric and protein requirements according to
ESPEN guidelines.
 In the rest of patients, both under and
overfeeding were present.
 During this pandemic parenteral nutrition was
used before enteral nutrition in our centre, and it
was associated with the pronation of the patients
during the first week of ICU admission.
Unidad de Nutrición
Clínica y Dietética
Table 1. Calories (kcal)
% caloric goal
Protein (g)
% protein goal
Adherenceto ESPEN
guidelines (calories)
Adherenceto ESPEN
guidelines (protein)
ICU:4th day 1282±614
74.2±35.2
60±31
66.8±34.9
28.3% 24.4%
ICU:7th day 1351±688
77.7±39.5
67.8±37
74.4±40.2
24.4% 28.1%
52,3
38,6
47,5
43,9
18,7
0
10
20
30
40
50
60
Overweight Obesity Hypertension Dyslipidaemia Diabetes
FIGURE 1. COMORBIDITIES
Rationale and Aims
Methods
Results Conclusions
ESPEN congress
September2020