Figure 2: Oral, enteral or parenteral nutrition depending
on clinical conditions.
It is possible to follow simple patterns of conduct. In the critical
patient in intensive care with respiratory failure for over 48 hours EN
medical nutritional therapy must be started with priority; PN nutrition
has been started for more than 3 days after EN strategies have failed to
avoid severe malnutrition. Overeating should always be avoided and a
gradual approach is best. The nutritional requirement in COVID-19 must
provide more energy than normal nutrition. Maintaining the energy
balance of patients with COVID-19 is fundamental. However, considering
the increased metabolic load in patients with severe pneumonia,
moderately low calories can reduce the metabolic load and excessive
energy intake is a risk factor. To reduce the catabolism due to
inflammatory mediators, it is indicated to increase protein intake as a
top priority. The supply of amino acids helps prevent muscle loss and
improve the strength of the respiratory muscles.
Given the importance clinical, ethical and economic action aimed at
reducing infections, including those from Covid-19, studies have always
been carried out which demonstrate how the correct supply of nutrients
can improve the prognosis and pathological course in ICUs. The use of
amino acids undoubtedly it improves the clinical course and favors the
prompt physiological recovery after a period of hospitalization. Then,
in the case of the covid patient, admitted to ICU with a strong
inflammatory state, it is shown how the adequate nutritional support of
glutamine, probiotics and lactoferrin helps to reduce the
pro-inflammatory molecules (IL-1, IL-6) responsible for the fatal event
pulmonary coronavirus.
All the figures of professionals and health workers, engaged in the
delicate task of facing and stemming the serious phenomenon, should be
more sensitized on the issue of nutrition-immunological ability, with
reference to both physiology and general pathology and disease
specifications in particular as in the case of Sars-Cov-2.
Alterations in muscle protein turnover, if the patient remains
hospitalized for a long time, could lead to physical disability.
Hypercatabolic activity if integrated with amino acids could limit
muscle hypercatabatabism (MH) (3-9).