Among hospitalized patients with COVID-19, the use of continuous positive airway pressure (CPAP) — delivered via face mask or hood — may lead to significant malnutrition, according to a correspondence published in The Lancet.

Although COVID-19-related anorexia, nausea, and taste impairment may lead to difficulties with the oral intake of food, these challenges are further exacerbated with the use of full-face or hood CPAP, as oral consumption of food is not possible without mask removal, leading to a reduction in arterial oxygen saturation.

The authors of the correspondence received reports that 3 patients with COVID-19 who were treated with CPAP had developed starvation ketosis, and other patients had gone up to 25 days without substantial oral intake of food of initiation of nutritional support. It is not uncommon for hospitalized patients with COVID-19 who are malnourished to experience muscle wasting, thereby necessitating mechanical ventilation.


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Although hospitalized patients with COVID-19 using CPAP may experience muscular atrophy and impaired gut function, the authors also noted that some health care centers used 0.9% saline as the routine and sole intravenous crystalloid, which does not comply with the National Institute for Health and Care Excellence clinical guideline 174; 0.9% saline can be used as a bolus for acute resuscitation, but is not recommended for routine maintenance, as the sodium and chloride load in the body can lead to bowel edema and additional impairment of gastrointestinal function.

“We recommend that health care professionals with expertise in nutrition, especially dietitians, nutrition nurses, physicians, and pharmacists, should be engaged in the assessment and care of all patients with COVID-19 who receive CPAP and patients who are subsequently admitted to intensive care units for mechanical ventilation,” the authors noted.

Reference

Turner P, Montgomery H, Stroud M, Grimble G, Smith T. Malnutrition risk in hospitalised COVID-19 patients receiving CPAP. Lancet. 2021;397(10281):1261. doi:10.1016/S0140-6736(21)00447-5