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The Role of a Registered Dietitian in COVID-19 Pandemic

The Role of a Registered Dietitian in COVID-19 Pandemic


Catherine Gruenfelder, who holds three degrees from the Saint Elizabeth University, works as a registered dietitian in the Intensive Care Unit at a local hospital. Registered dietitians are vital in ensuring that COVID-19 patients are well nourished, which gives them a better chance of fighting the virus.

This is her story.

Morristown, N.J. (May 26, 2020) – Registered dietitians play a crucial role in the medical management of COVID patients. COVID presents as a severe respiratory disease. When you can’t breathe, you can’t eat. In addition, critical illness dramatically increases metabolic needs. That’s a problem. In this setting, a patient’s metabolic needs are higher, but their nutritional intake is compromised. Patients can become malnourished very quickly, no matter their pre-morbid health or weight. It is very important to keep these patients well-nourished, with the appropriate macro and micronutrients in order to fight this insidious disease. Registered dietitians manage this component of critical care.

In the Intensive Care Unit, most COVID patients are on ventilators. When someone is on a ventilator, they are sedated and can’t eat orally. They require enteral (tube) feedings to help them meet their nutritional needs. Every patient is different and tube-feedings need to be customized to that patient and adjusted daily according to changes in their medical status. There are many different tube-feeding formulas and one size certainly does not fit all.

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.

Registered dietitians manage these feedings. It is challenging work as the medical status of COVID patients can change rapidly and feedings need to be adjusted along with those changes. You have to be a team player, and I have great respect for my critical care team who are so easy to communicate with and always eager to learn more about nutrition.

  In the COVID floor (non-ICU), most patients require high levels of supplemental oxygen. Depending on oxygen administration, these patients can also have very poor nutritional intakes. Many times they have been sick for weeks with very poor nutritional intakes in order to delay coming to the hospital. These patients are also at risk of malnutrition and must be provided with appropriate nourishment to help them meet their higher nutritional needs in such a metabolically stressed state.

Respiratory muscles need energy just as much as the rest of the body. Also, many of these patients are self-proning, sometimes for 16-18 hours/day. Proning means laying on your stomach, which can help improve oxygenation to the lungs. When you are proning, you can’t really eat. The Registered Dietitian has to come up with strategies to maximize nutrition when not proning. This can include many nutrient-dense and modified foods to help increase calorie and protein intake in a shorter period of time.

Working with patient preferences is key – when you don’t feel well, you absolutely don’t want to eat things you don’t like. Usual dietary restrictions may not apply in favor of maximizing overall intake of protein and calories.

   It’s been stressful, exciting and depressing all at the same time. In the beginning, I felt panic watching the critical care census rise so quickly and hearing the codes called overhead constantly. CODE BLUE. ANESTHESIOLOGY STAT. Even though we knew it was coming, it seemed to hit all of a sudden over one weekend at the end of March – the surge. We were prepared – thank God. So many enteral feeding orders – that’s all I did all day, every day. I followed those patients and monitored their feedings and medical status.

COVID patients tend to stay on the ventilators for a very long time. When the first one was extubated (successfully taken off the ventilator and able to breathe on their own), we celebrated in the diet office. You can’t imagine how good it feels to see a patient that you have cared for, carefully adjusting their feeding and nutritional needs, finally being extubated and eating on their own. That makes everything worth it.

  Working as a clinical dietitian during the pandemic has been challenging. This was not what I signed up for when applying to work as a dietitian in an acute care hospital. I wear scrubs and a surgical mask at work daily. I wipe down work-stations with alcohol wipes constantly. I wear an N95 mask when I have direct patient contact. When I come home, I remove my shoes and proceed directly to the shower daily to protect my family. I have not seen my parents (in their 70s) since February and don’t plan to until we have more answers. But, I’m sure, no one else signed up for this, either, and most healthcare workers are doing the same thing. So, we all do our part, take care of our patients, take care of ourselves, and take care of each other.

I have never felt more love from my community than I do now and that just motivates me to keep doing more for them.