15/01/2021
After the family meeting we had last night and the fact that SA has moved back to level 3. We thought a COVID post might be applicable.
As most of you know - Chanelle (our dietitian) is also working in the hospital (in the ICU setting specifically). That is why we only have consultation slots available from 13:00 onward.
In the last 2 or 3 weeks we have seen a HUGE spike in COVID admissions, to such an extent that the ICU that Chanelle is working in has turned into a 100%, full blown COVID ICU.
But why?? Why do they need a Dietitian in the ICU?? That is the question we have been getting more and more the last 2 or 3 weeks.
Well - there are many reasons.... But one thing we have seen is that lots of these COVID patients tell us "I can't eat, I am too busy trying to breathe..." So, dietitians then assess the situation. We assess the current nutritional status of the patient. We assess the risk profile of the patient. We calculate their nutritional needs and we then supply the patient with additional nutritional support in the form op sip feeds (almost like a small milkshake*). These milkshakes are usually easier for these patients to consume. By taking these extra milkshakes, we can help the patients to not lose too much lean body mass (or muscles, which is a HUGE problem in the ICU).
* Each of these milkshakes have very specific characteristics. Some are higher in calories, some are high in protein, some are low in protein, some are for diabetics, some are very small volumes, some are sweet, some are salty, some are thickened, some have extra added stuff to them that make them really really cool. Almost like tiny superheroes in small bottles.
If a patient can't breathe on his or her own, the ICU staff needs to unfortunately intubate the patient (this is the tube that goes down into your lungs). Once you are intubated, you can't eat at all and we have to place a NGT (Nasogastric tube). This tube goes in through your nose (sometimes your mouth - then it is called an orogastric tube) into your stomach. We then calculate your nutritional needs and calculate something we call enteral feeds. These are bags with feeds (usually 500ml or 1000ml). These bags also have very cool features and characteristics.
Early and appropriate enteral feeding has been shown to reduce time on the ventilator and to lead to better medical outcomes. In simpler terms, all of our organs and tissues need proper energy to work. They need even more energy when they are stressed. Feeding patients appropriately means that their lungs, heart, brain, kidneys and liver have the tools they need to do their jobs.
We can also do something that we call parenteral nutrition or PN. This is when we can't use the stomach or gut at all and we have to feed the patient straight into the veins. This is really dangerous and lots of care should go into calculating the specific requirements, ordering the appropriate bag and administering the bag to the patient. We use PN mostly for patients that had major gut surgery. or have an ischemic bowel or was shot in the stomach etc.
But - our job doesn't end there. Everyday we have to monitor the patient. To see if the patient is tolerating and absorbing the prescribed feeds. We do this by looking at lots of factors such as blood results, clinical signs, input and output charts etc. It is challenging work as the medical status of COVID patients can change rapidly and feedings need to be adjusted along with those changes
Dietitian form part of the ICU multi-disciplinary team and we are part of the daily ICU ward round with the Intensivists, doctors, nursing staff etc.
