Nutrition Guidelines for Patients with COVID-19 - Relevance to PTs

Nutrition Guidelines for Corona Virus

The European Society for Clinical Nutrition and Metabolism, also known as ESPEN, have released pre-published guidelines for clinicians to consider for patients with COVID-19 (novel Corona virus). The guidelines offer a great breakdown of evidenced-based statements related to managing patients in the intensive care unit (ICU), outpatient and those in quarantine.

Relevance to PT Practice

Physical therapists (PTs) are considered essential during the COVID-19 crisis. Physical therapists are being utilized in ICUs to help position patients, particularly in prone, which helps to improve lung perfusion. Moreover, PTs are helping mobilize and get those stronger after being infected. Let's look at the ESPEN Statements and see how they impact PT practice.

One of the first pieces of guidance ESPEN offers is that patients with COVID-19 should be screened for malnutrition. Some PTs are trained in nutritional screening, which will facilitate the immediate consult of registered dietitian (RD) or specialized medical doctor. The following screening tools are recommended:

1. Must criteria: see https://www.bapen.org.uk/screening-and-must/must-calculator 85
2. NRS-2002 criteria: https://www.mdcalc.com/nutrition-risk-screening-2002-nrs-2002

These screening tools involve simple inputs such as the patient's weight, if there's been a reduction in eating, and if the patient is ill. These basic questions and measures can help PTs get patients to RDs and MDs for nutrition counseling ASAP. Referral to these qualified providers is the second major recommendation from ESPEN. PTs should not be offering nutrition counseling solely to patients with or recovering from COVID-19. It takes a team!

ESPEN offers guidance that patients with COVID-19 will likely need higher daily caloric intake, as well as an increase of protein to 1g/day to over 1g/day for patients with comorbidities. Individuals with malnutrition would like benefit from supplementation of non-supraphysiologic certain vitamins and trace minerals such as Vitamin A, Vitamin B, Vitamin C, Zinc, and Selenium. PTs can encourage patients during visits to comply with such supplementation regimes prescribed by RDs or physicians. 

The next major recommendation by ESPEN is that patients in quarantine should maintain physical activity! Now this recommendation is clearly in the wheelhouse of PTs. The guidelines cite that patients should utilize exercise videos, Tai Chi, weight-bearing movements as effective ways to stay healthy. Simple movements like squats, chair dips, push ups, planks, and walking are easy to do almost anywhere! Staying moving will prevent weight gain, depression, keep calorie intake up, and possibly boost immunity.

The final several ESPEN recommendations orient around oral nutritional supplements (ONS) and enteral feeding. ONS ought to be considered for those with malnutrition and should contain 400 kcal/day and 30g of protein to help normalize a patient's nutritional status. Failing this or if a patient progresses into the ICU, the medical team is encouraged to further tackle malnutrition in the critically ill through enteral feeds, best done through nasogastric (NG tubes). NGs are preferred due to the prone positioning of patients with COVID19. PTs working in the ICU need to be aware of the NG tube placements and help clinicians with mobilizations to prevent pressure sores and to optimize respiration. 

Summary

The current ESPEN Guidelines for the Corona virus have several factors that practicing physical therapists need to be aware of. The guidelines include factors that affect patients in outpatient, skilled nursing, home, and hospital settings. Consider reading the pre-published guidelines below and then check out our amazing evidenced-based, board-approved continuing education courses for physical therapists!

Stay well and be safe!

ESPEN Guidelines for COVID 19:

https://www.espen.org/files/Espen_expert_statements_and_practical_guidance_for_nutritional_management_of_individuals_with_sars-cov-2_infection.pdf?__s=qyzmvkrqpugubshgivhf

Keywords: Physical therapy, corona virus, guidelines, nutrition, courses