In this tutorial, we are joined by Charlotte Dowd, Dietitian in Cardiff and Vale University Health Board, who provides an overview of the nutritional support for patients on a COVID-19 ward.

Patients with COVID-19 are at high risk of malnutrition, due to gastrointestinal problems, taste and smell changes, and oxygen and CPAP masks making it more difficult to eat and drink.  If a patient is overweight or obese, they can still be at risk of malnutrition and sarcopenia. Early identification of patients at risk of malnutrition is key for these patients, and a validated nutrition risk screening tool is recommended. If a patient is at risk of malnutrition, a specialist dietitian should be consulted.

Nutritional support should include the following steps:

1. Oral nutrition, including foods that are softer in texture for patients who are breathless, and high energy and high protein nutrition supplement drinks
2. Enteral nutrition
3. Parenteral nutrition

Nasogastric (NG) tubes should be placed early on, because patients can become dependent on their NIV, CPAP or oxygen therapy. Early signs that patients may need to be escalated from oral nutrition to enteral nutrition include:

• Worsening oxygen levels, requiring increasing time on their NIV/ CPAP
• Patients who are more fatigued and tired
• Patients who are managing less than 50% of their nutritional requirement

Parenteral nutrition can be used with support from the MDT if adequate nutritional support is unable to be delivered or tolerated with oral or enteral nutrition.