Lack of hemodynamic changes in critically ill Covid-19 patients using enteral nutrition with arginine: A prospective observational study

Abstract

Summary: Background & Aims: This study aims to correlate recommended arginine doses for an immunomodulatory effect to hemodynamic changes during the first week of enteral nutrition (EN) in SARS-CoV-2 patients. Methods: This is a prospective observational study of critically ill SARS-CoV2 patients. Patients were followed during the early ICU acute phase. EN was administered according to gastrointestinal tolerance to feeding. Arginine doses were correlated with hemodynamic, perfusion, and IV drug changes. Results: From December 2020 to May 2021, we prospectively and sequentially included 64 SARS-CoV-2 patients. Supplemental arginine delivered above the recommendations for normal individuals (≥6 g/d) did not result in significant hemodynamic changes measured by mean arterial pressure (MAP), systolic arterial pressure (SAP), need for higher vasopressors doses, or tissue hypoperfusion clinical signs (P = 0.063). Arginine doses >10g/day were reached on the fifth ICU admission day. Addition of arginine did not increase vasopressor requirements (mean dose <2.0 mcg/min; 95%CI 1.12; 2.73). The study patients showed no other sign of hypoperfusion, such as increased lactate, metabolic acidosis, or oliguria. Fitted regression model shows no significant effect of arginine dose on MAP (P = 0.29). Conclusion: Enteral arginine supplementation in critically ill patients with SARS-CoV-2 is not associated with hemodynamic instability or organ hypoperfusion. This study suggests that it is safe to study the potential benefit of arginine supplementation including its possible immunologic benefits during the first week in critically ill patients with SARS-CoV-2.

Keywords

• SARS-CoV-2
• COVID-19
• Arginine
• Enteral nutrition
• Hemodynamics