Functional Recovery and Nutrition Management among Severe COVID-19 Cases during Post-extubation Hospitalization: A Case Series

BACKGROUND: Many patients with coronavirus disease 2019 (COVID-19) develop malnutrition after a prolonged stay in the intensive care unit (ICU) with mechanical ventilation. Early enteral nutrition is recommended, but optimal nutrition management during post-extubation recovery remains challenging. CASES: The subjects were 12 acute respiratory distress syndrome patients with COVID-19 (9 men, 3 women; median age, 55.6 years). We reviewed patient characteristics, physical function, and nutrient intake during hospitalization from just after extubation to discharge. During this period, the median Functional Oral Intake Scale score improved from 4.5 (interquartile range [IQR] 3.3–5.3) to 7.0 (IQR 5.8–7.0), the median Medical Research Council (MRC) scale score improved from 45.0 (IQR 39.3–48.5) to 53.5 (IQR 47.5–59.3), and the median Barthel index improved from 7.5 (IQR 0–16.3) to 72.5 (IQR 42.5–95.0). In 3 patients, the MRC scale score remained below 48 before discharge, indicating that ICU-acquired weakness had been prolonged. The median daily caloric intake during this phase increased from 6.9 kcal/kg per day (3.5–10.2 kcal/kg per day) to 24.8 kcal/kg per day (21.0–27.9 kcal/kg per day). About half of these patients showed caloric intake below 25 kcal/kg per day before discharge. Based on the Global Leadership Initiative on Malnutrition (GLIM) diagnostic scheme, 10 patients were diagnosed with malnutrition during hospitalization. DISCUSSION: Physical function improved in more than half of the patients, but nutritional status was not recovered. More studies for nutritional management are required to prevent malnutrition and to enhance functional recovery during the post-extubation rehabilitation phase.