Written by Doron Besser, CEO of ENvizion
Even as vaccines roll out and some parts of the world begin to reopen, it seems new mutations of the COVID-19 pandemic are sprouting every week. Vaccines have proven effective so far in countries such as Israel, but rollouts remain slow elsewhere and health systems are still grappling with the pandemic. One issue growing in urgency is the management of nutrition for ICU patients, which has become significantly complex in delivering effectively.
In patients suffering from COVID-19, the effects of the virus invariably result in reduced food intake and an increased muscle catabolism for patients, wherein immediate nutrition is crucial for patients who are mechanically ventilated in an ICU. Because of this, patients remain at risk of a significant deterioration in their medical condition, or even death, if they do not receive adequate nutrition through a feeding tube. Since the pandemic hit, the need to therefore minimize malnutrition has grown in both complexity and urgency.
Long before COVID-19 hit the headlines in early 2020, certain practices within medicine have long-sought improvements to increasingly obsolete methods. The more our technology and expertise matures, the more medical analysts can delve into variables and patterns that were previously obscured. Research has become much more immersed in discovering causation by looking deeper into how communication breakdowns, diagnostic errors, poor personal judgement, and inadequate level of qualifications can directly result in patient harm or death. Early enteral nutrition, provided within 24 hours of injury or intensive care unit admission, significantly reduces mortality in critically ill patients, according to 2009 research by the National Center for Biotechnology Information. Subsequently, the relationship between high-risk, ICU admissions and timely nutritional support become a topic of growing concern in the medical industry.
Malnutrition and the old way
If the issue of malnutrition wasn’t already complicated enough prior to 2020, the pandemic certainly magnified it. Despite the enormous investment of resources, a sound understanding of nutrition issues among patients at risk for, actively infected with, or recovering from COVID-19 remained elusive at the early stages. Initially, governing medical bodies released stringent guidelines for managing critically ill patients, which uniformly relied on evidence and recommendations from non-COVID critical illness and acute respiratory distress syndrome. None of the recommendations were based on trials conducted in critically ill patients with COVID-19, because such data was not available at the time.
Effectively combating malnutrition requires having sufficient resources to do so, but with hospital wards bursting at the seams, the issue has remained a sore-point. Fifteen percent of COVID-19 patients required hospital stays, and 10 percent of them needed urgent respiratory and hemodynamic support in the intensive care unit (ICU). This placed more immediate pressure on hospital wards trying to manage the crisis, particularly institutions with a scarce amount of beds and lackluster ICU infrastructures. By December 2020, more than a third of Americans were living in areas where hospitals reported being critically short of intensive care beds, according to federal data.
With enteral feeding supplies already behind the curve prior to the pandemic, hospitals found themselves on the short end of the stick to a greater extent. In some cases, mass arrivals of patients needing urgent respiratory care and artificial ventilation made reorganizing hospital care, wards, and staff a necessity. At the start of the pandemic, due to a shortage of mask and other protective material, the risk of contamination among healthcare workers even led some wards to prohibit using enteral-type nutrition because nasogastric tube insertion is an aerosol-generating procedure.
How has our approach changed?
Tech entrepreneurs and medical innovators alike have worked day and night to come up with new ways to combat the predicament, which has added some much-needed momentum to improving obsolete enteral feeding methods. The industry consensus is leaving behind archaic medical directives, which traditionally assured doctors that passage of a nasogastric tube into the trachea was unlikely and, if it did happen, a sudden “stop” would alert the clinician. Those texts proved overly reassuring, and it became clear that improvements were needed. Research about the old ways has led to intriguing discussion points, medical innovations, and collaborations, with newer methods that significantly emphasize placement, timing, and methods of enteral feeding delivery for patients.
Movements, such as the Patient Safety Movement Mission, were recently born out of a yearning to eliminate preventable harm and death in healthcare. These sorts of collaborative movements that raise awareness in the right places, and their presence will only serve to combat malnutrition more effectively. Through the rise of telehealth applications, collaborative efforts have led to more active strategies of nutritional screening for COVID-19 patients, where patients are able to submit data remotely prior to entering an ICU unit.
The crisis created by the pandemic further solidified how important the rapid diagnosis of malnutrition, particularly for those in intensive care is. In the last ten years, a growing movement emerged amongst medtech innovators to improve patient safety by refining processes which have been stuck in the mud for far too long and left patients at high-risk for complications. While the COVID-19 has compounded certain pre-disposed shortcomings in our approach, it has also illuminated important shortcomings and ensured that our focus on combating malnutrition will persist far beyond our most current necessities.