Clinical heavy patients of COVID 19 are characterized by disturbance of food. Providing food is vital, especially at a complication infections and organ insufficiency. Sepsis — one of therapeutic states at which nutritive support leads to decrease in the time spent of patients in ORIT and lethality. Considering that the average duration of IVL at patients with COVID 19 is about 14 days, these patients are in a zone of risk of a hypotrophy.
It is more preferable to use food via the probe instead of parenteral food at a disease peak stage (the first 5–7 days). Due to the undesirable overload of patients liquid, volumes of parenteral food or food via the probe need to be regulated and, in case of need, to reduce.
Contraindications include:
a) an unstable hemodynamics, despite input of fluids and vazopressor;
b) uncontrollable anoxemia, hypercapnia, acidosis;
c) emergence of blood in a stomach or intestines;
d) intestinal ischemia with or without impassability;
e) mechanical ileitis;
e) shift of abdominal organs;
g) residual contents of a stomach more than 500 ml in 6 hours.
The enteroalimentation has to begin as soon as possible (during 24–48 h from the moment of hospitalization in ORIT), after achievement of satisfactory level of a hemodynamics and in case of absence uncontrollable hypoxias and hypercapnias. The stable hypoxia and an easy hypercapnia are not contraindications to start an enteroalimentation. The nutritious nazogastralny probe has to be installed to the patient at once. Considering need of administration of pharmacological drugs, it is more preferable than use of the probe with high caliber — 14 Fr. The enteroalimentation has to begin with the standard polymeric mix given at a low speed (10–20 ml an hour), with addition (preferably at night, considering a photosensitization of separate substances) micronutrients, since first day, first of all thiamin (100–300 mg/day), a multivitamin complex (1 ampoule a day), various microelements (1 ampoule a day). The volume of enteral mix increase before achievement 1500 ml a day. Gradually increase mix feed rate depending on shipping, before achievement of 20-25 kcal a day. It is necessary to interrupt or reduce mix feed rate in case of symptoms of intolerance (pains, abdominal distention, an eructation> of 500 ml each 6 hours).
The optimum amount of proteins and calories at the beginning of a disease (the first 5–7 days) is unknown. At this stage contraindicated raised ratio of calories and proteins because of risk of an overload of the patient and metabolic changes, such as hyperglycemia, and here hypocaloric or supporting can do the EDS for maintenance of a trophicity good. It is also necessary to consider energy value of innutritious means to avoid glut. When the acute phase of a disease passed, in the absence of a direct calorimetry, it is necessary to give 25230 kcal on kg a day and 1.5 g/kg of proteins a day. This range can be changed depending on a glycemia and an azotemia.
Situation facedown (pron-position) is not a contraindication to the EDS. No powerful clinical differences in volume of residual gastric contents when finding the patient were revealed facedown concerning situation on spin. The protocol of variation of volume of residual contents of a stomach allows to provide safe and effective the EDS even at the patients lying on a stomach during the long time. In case of increase in residual gastric contents more than 500 ml within 6 hours, are recommended to enter prokinetics as soon as possible. The used prokinetics: erythromycin in/in, choice drug (100–250 mg 3 r in day within 2–4 days) or Metoclopramidum (10 mg in/in 3 r in day) or their mix. Important: the efficiency of these substances decreases on a third after 72 h therefore their introduction should not exceed three days. In case a large number of residual contents in a stomach after 48/72 hours remains, it is worth applying postpyloric food. If it is impossible, then it is worth passing to parenteral food with the lowered calorie content and proteins in order to avoid glut of the patient.
Use of parenteral food as the basic or additive to an enteroalimentation is provided, when there is no an opportunity to bring enough nutrients only by means of the EDS, owing to intolerance or in the presence of contraindications, since 5-7 in the afternoon hospitalization. In spite of the fact that parenteral food is considered to be the reason of the worst results, the last researches showed that the true reason of complications is excess of the caloric content (glut), but not how calories got to an organism. Parenteral food has to proceed as addition to enteral or for its replacement until requirements of an organism are not satisfied only with an enteroalimentation.