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).