Home medical nutrition during SARS-CoV-2 pandemic - A position paper.

Michal Lawiński, Agata Zoubek-Wojcik, Krystyna Urbanowicz, Kinga Szczepanek, Waldemar Szafranski, Magdalena Sumlet, Jacek Sobocki, Maciej Sadowski, Katarzyna Matysiak-Lusnia, Maciej Matczuk, Krystyna Majewska, Przemyslaw Matras, Marek Kunecki, Katarzyna Klepczyk, Zbigniew Kamocki, Marlena Jakubczyk, Wlodzimierz Cebulski, Lidia Bartoszewska, Anna Zmarzly, Marcin Folwarski, Stanislaw Klek

Journal: Clinical nutrition ESPEN 2020;38():196-200

PMID: 32690158

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Abstract

BACKGROUND

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a worldwide rapidly spreading illness, Coronavirus Disease 2019 (COVID-19). Patients fed enterally and parenterally at home are exposed to the same risk of infection as the general population, but more prone to complications than others. Therefore the guidance for care-givers and care-takers of these patients is needed.

METHODS

The literature search identified no relevant systematic reviews or studies on the subject. Therefore a panel of 21 experts from 13 home medical nutrition (HMN) centres in Poland was formed. Twenty-three key issues relevant to the management of SARS-CoV-2 infection or COVID-19 in the HMN settings were identified and discussed. Some statements diverge from the available nutrition, surgical or ICU guidelines, some are based on the best available experience. Each topic was discussed and assessed during two Delphi rounds subsequently. Statements were graded strong or weak based on the balance between benefit and harm, resource and cost implications, equity, and feasibility.

RESULTS

the panel issued 23 statements, all of them were graded strong. Two scored 85.71% agreement, eleven 95.23%, and ten 100%. The topics were: infection control, enrolment to HMN, logistics and patient information.

CONCLUSIONS

the position paper present pragmatic statements for HMN to be implemented in places without existing protocols for SARS-CoV-2 pandemic. They represent the state of knowledge available at the moment and may change should new evidence occurs.

Address: First Department General and Transplant Surgery and Clinical Nutrition Medical University of Lublin. Home Enteral and Parental Nutrition Unit SPSK4, Lublin, Poland.; Stanley Dudrick's Memorial Hospital, General Surgery Unit with Intestinal Failure Center, Skawina, Poland. Electronic address: [email protected].; Department of Clinical Nutrition and Dietetics, Medical University of Gdansk, Copernicus Hospital, Home Enteral and Parental Nutrition Unit, Gdansk, Poland.; Regional Gromowski's Hospital, Center for Nutritional Therapy, 2nd Department for Infectious Diseases, Wroclaw, Poland.; Department of General, Gastroenterological and Cancer Surgery, Warsaw Medical School, Warsaw, Poland.; Department of Anaesthesiology and Intensive Care Collegium Medicum in Bydgoszcz. Nicolaus Copernicus University in Toruń, Poland; Nutritional Team, Home Enteral and Parenteral Nutrition Clinic University Hospital No. 1 in Bydgoszcz, Poland.; 2nd Department for General and Gastroenterology Surgery, Bialystok, Poland.; Center for Clinical Nutrition, M Pirogow's Hospital, Lodz, Poland.; Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, Warsaw, Poland.; Regional Paediatric Hospital, Center for Clinical and Home Nutrition, Gizinscy Medical Center, Bydgoszcz, Poland.; Medical University of Wroclaw, Poland; Department and Clinic of Anaesthesiology and Intensive Therapy, Enteral and Parenteral Nutrition Outpatient Clinic, Voyevodin Hospital, Jelenia Gora, Poland; Home Hospice and Palliative Care Ward, Voyevodin Hospital, Jelenia Gora, Poland.; Regional Hospital of the Province Olsztyn, Enteral and Parenteral Nutrition Unit, Poland.; Stanley Dudrick's Memorial Hospital, General Surgery Unit with Intestinal Failure Center, Skawina, Poland.; Copernicus Hospital, Home Enteral and Parental Nutrtion Unit, General Surgery Unit, Gdansk, Poland.; Nutrimed Home Nutrition Center, Rzeszow, Poland.

DOI: 10.1016/j.clnesp.2020.05.002