A diet protocol for patients on non-invasive ventilation admitted to a healthcare unit in a tertiary referral center in southern Brazil

Authors

  • Juliana Peçanha Antonio Universidade Federal do Rio Grande do Sul, Serviço de Nutrição e Dietética, Hospital de Clínicas de Porto Alegre. Porto Alegre, RS, Brasil. https://orcid.org/0000-0003-0030-738X
  • Carolina Ribeiro Anele Universidade Federal do Rio Grande do Sul, Serviço de Nutrição e Dietética, Hospital de Clínicas de Porto Alegre. Porto Alegre, RS, Brasil. https://orcid.org/0000-0002-3706-7845
  • Renata Schwartz Universidade Federal do Rio Grande do Sul, Serviço de Nutrição e Dietética, Hospital de Clínicas de Porto Alegre. Porto Alegre, RS, Brasil. https://orcid.org/0000-0001-5093-8062
  • Michelle Nunes Silveira Universidade Federal do Rio Grande do Sul, Serviço de Nutrição e Dietética, Hospital de Clínicas de Porto Alegre. Porto Alegre, RS, Brasil. https://orcid.org/0000-0002-0984-8169
  • Thais Ortiz Hammes Universidade Federal do Rio Grande do Sul, Serviço de Nutrição e Dietética, Hospital de Clínicas de Porto Alegre. Porto Alegre, RS, Brasil. https://orcid.org/0000-0001-8010-3840
  • Mariana Rangel Ribeiro Falcetta Universidade Federal do Rio Grande do Sul, Serviço de Medicina Interna, Hospital de Clínicas de Porto Alegre. Porto Alegre, RS, Brasil. https://orcid.org/0000-0002-9300-4013
  • Ana Maria Keller Jochims Universidade Federal do Rio Grande do Sul, Serviço de Nutrição e Dietética, Hospital de Clínicas de Porto Alegre. Porto Alegre, RS, Brasil. https://orcid.org/0000-0001-5078-5238
  • Valesca Dall'Alba Universidade Federal do Rio Grande do Sul, Serviço de Nutrição e Dietética, Hospital de Clínicas de Porto Alegre. Porto Alegre, RS, Brasil. https://orcid.org/0000-0002-8896-3199
  • Vera Lúcia Bosa Universidade Federal do Rio Grande do Sul, Serviço de Nutrição e Dietética, Hospital de Clínicas de Porto Alegre. Porto Alegre, RS, Brasil. https://orcid.org/0000-0002-6283-9640

DOI:

https://doi.org/10.12957/demetra.2025.74941

Keywords:

COVID-19. SARS-CoV-2. Non-invasive Ventilation. Diet. Nutrition Therapy

Abstract

Introduction: The COVID-19 pandemic posed unprecedented challenges and threats to patients and healthcare systems worldwide. The high risk of malnutrition highlighted the importance of early nutrition intervention. Objective: To develop a personalized dietary protocol for patients requiring non-invasive ventilation (NIV). Methods: This was a descriptive observational study included adult NIV patients admitted to a tertiary referral center in southern Brazil between March and August 2021. Patients received a dietary protocol consisting of a fractionated, liquidized and pureed diet, supplemented with isolated whey protein. The protocol provided 2,000 kcal/day and 90 g of protein/day. Food intake was continuous monitored using a visual intake scale. The study was approved by the hospital’s ethics committee. Results: A total of 176 patients were evaluated, most male (57%), with a mean age of 56 ± 15 years. The median onset of respiratory symptoms was 9 days. According to the NRS-2002, 83% of the patients were classified as being at risk of malnutrition. Upon admission, 86% required oxygen support, and 94% were exclusively fedorally, with 50% receiving the prescribed diet protocol. Patients on NIV consumed more than half of the prescribed diet and were able to progress to a regular consistency diet by discharge. Conclusion: A fractionated, modified-consistency diet that is easy to chew appears to be a feasible alternative to nasoenteric tube feeding for patients on NIV. In this context, nutritional therapy should be considered a fundamental component of care for these patients in all healthcare settings.

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References

1. Silverio R, Gonçalves DC, Andrade MF, Seelaender M. Coronavirus Disease 2019 (COVID-19) and Nutritional Status: The Missing Link?. Advances in Nutrition, 2021;12(3):682-292. https://doi.org/10.1093/advances/nmaa125

2. Haraj NE, El Aziz S, Chadli A, Dafir A, Mjabber A, AissaouiO,etal.Nutritional status assessment in patients with Covid-19 after discharge from the intensive care unit. Clin. Nutr. ESPEN,2021;41:293-300. https://doi.org/10.1016/j.clnesp.2020.09.214

3. Osuna-Padilla IA, Rodríguez-Moguel NC, Aguilar-Vargas A, Rodríguez-Llamazares S. High nutritional risk using NUTRIC-Score is associated with worse outcomes in COVID-19 critically ill patients. Nutr Hosp. 2021;38(3):618-24. http://dx.doi.org/10.20960/nh.03440

4. Silva DFO, Lima SCVC, Sena-Evangelista KCM, Marchioni DM, Cobucci RN, de Andrade FB. Nutritional risk screening tools for older adults with covid-19: A systematic review. Nutrients. 2020;12(10):2956. https://doi.org/10.3390/nu12102956

5. Liu A, Cong J, Wang Q, Mei Y, Peng Y, Zhou M, et al. Risk of Malnutrition Is Common in Patients with Coronavirus Disease 2019 (COVID-19) in Wuhan, China: A Cross-sectional Study. J Nutr. 2021;151(6):1477-83. https://doi.org/10.1093/jn/nxab009

6. Windisch W, Weber-Carstens S, Kluge S, Rossaint R, Welte T, Karagiannidis C. Invasive and Non-Invasive Ventilation in Patients With COVID-19. DtschArztebl Int. 2020;117(29-30):528-33. https://doi.org/10.3238/arztebl.2020.0528

7. Sbaih N, Hawthorne K, Lutes J, Cavallazzi R. Nutrition Therapy in Non-intubated Patients with Acute Respiratory Failure. CurrNutr Rep. 2021;10(4):297–305. https://doi: 10.1007/s13668-021-00367-z

8. Singer P, Robinson E; Hellerman-Itzhaki M. Nutrition during noninvasive respiratory support. CurrOpinCritCare. 2024;30(4):285–91. https://doi: 10.1097/MCC.0000000000001171

9. Centers for Disease Control and Prevention. Division of Viral Diseases. CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel, 2020.[Acesso 21 maio 2025]. Disponível em: https://www.fda.gov/media/134922/download

10. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. ClinNutr. 2003;22(4):415-21. https://doi.org/10.1016/S0261-5614(03)00098-0

11. Secretaria Estadual de Saúde do Rio Grande do Sul (SES). Centro Estadual de Vigilância em Saúde. Boletim Epidemiológico COVID-2019: Centro de Operações de Emergência do Rio Grande do Sul/COERS. [Acesso 21 maio 2025]. Disponível em: https://coronavirus.rs.gov.br/upload/arquivos/202103/13160241-boletim-epidemiologico-covid-19-coers-se-09.pdf

12. Barazzoni R, Bischoff S, Breda J, Wickramasinghe K, Krznaric Z, NitzanD,etal.ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. ClinNutr. 2020;39(6):1631–8.https://doi.org/10.1016/j.clnu.2020.03.022

13. Cintoni M, Rinninella E, Annetta MG, Mele MC. Nutritional management in hospital setting during SARS-CoV-2 pandemic: a real-life experience. Eur J ClinNutr. 2020;74(5):748–51.https://doi.org/10.1038/s41430-020-0625-4

14. Formisano E, Di Maio P, Ivaldi C, Sferrazzo E, Arieta L, Silvia Bongiovanni S, et al. Nutritional therapy for patients with coronavirus disease 2019 (COVID-19): Practical protocol from a single center highly affected by an outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Nutrition. 2021;82:111048. https://doi.org/10.1016/j.nut.2020.111048

15. Caccialanza R, Laviano A, Lobascio F, Montagna E, Bruno R, LudovisiS,etal.Early nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): Rationale and feasibility of a shared pragmatic protocol. Nutrition. 2020;74:110835. https://doi.org/10.1016/j.nut.2020.110835

16. Saueressig C. Ferreira PK, Glasenapp JH, Dall'Alba V. Food Intake Visual Scale-A practical tool forassessing the dietary intake of hospitalized patients with decompensatedcirrhosis. NutrClinPract 2023 Feb;38(1):187-198. https://doi.org/10.1002/ncp.10840

17. Reeves A, White H, Sosnowski K, Tran K, Jones M, Palmer M. Energy and protein intakes of hospitalised patients with acute respiratory failure receiving non-invasive ventilation. Clin Nutr. 2014;33(6):1068–73. https://doi.org/10.1016/j.clnu.2013.11.012

18. Terzi N, Darmon M, Reigner J, RucklyS,Garrouste-Orgeas M, Lautrette A, et al. Initial nutritional management during noninvasive ventilation and outcomes: A retrospective cohort study. CritCare. 2017 Nov 29;21(1):293. https://doi.org/10.1186/s13054-017-1867-y

19. Crenitte MRF, Avelino-Silva TJ, Apolinario D, Curiati JAE, Campora F, Jacob-Filho W. Predictors of Enteral Tube Feeding in Hospitalized Older Adults. JPEN J Parenter Enteral Nutr. 2017;41(8):1264–70. https://doi.org/10.1177/0148607116683142

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Published

2025-07-29

How to Cite

1.
Antonio JP, Anele CR, Schwartz R, Silveira MN, Hammes TO, Falcetta MRR, et al. A diet protocol for patients on non-invasive ventilation admitted to a healthcare unit in a tertiary referral center in southern Brazil. DEMETRA [Internet]. 2025 Jul. 29 [cited 2025 Sep. 13];20:e74941. Available from: https://www.e-publicacoes.uerj.br/demetra/article/view/74941

Issue

Vol. 20 (2025)

Section

Clinical Nutrition

License

Copyright (c) 2025 Juliana Peçanha Antonio, Carolina Ribeiro Anele, Renata Schwartz, Michelle Nunes Silveira, Thais Ortiz Hammes, Mariana Rangel Ribeiro Falcetta, Ana Maria Keller Jochims, Valesca Dall'Alba, Vera Lúcia Bosa

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This work is licensed under a Creative Commons Attribution 4.0 International License.

 

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