Feeding intolerance in critically ill patients with COVID-19
Open accessAbstract
Background & aims Early reports suggest significant difficulty with enteral feeding in critically ill COVID-19 patients. This study aimed to characterize the prevalence, clinical manifestations, and outcomes of feeding intolerance in critically ill patients with COVID-19.Methods We examined 323 adult patients with COVID-19 admitted to the intensive care units (ICUs) of Massachusetts General Hospital between March 11 and June 28, 2020 who received enteral nutrition. Systematic chart review determined prevalence, clinical characteristics, and hospital outcomes (ICU complications, length of stay, and mortality) of feeding intolerance.Results Feeding intolerance developed in 56% of the patients and most commonly manifested as large gastric residual volumes (83.9%), abdominal distension (67.2%), and vomiting (63.9%). Length of intubation (OR 1.05, 95% CI 1.03-1.08), ≥1 GI symptom on presentation (OR 0.76, 95% CI 0.59-0.97), and severe obesity (OR 0.29, 95% CI 0.13-0.66) were independently associated with development of feeding intolerance. Compared to feed-tolerant patients, patients with incident feeding intolerance were significantly more likely to suffer cardiac, renal, hepatic, and hematologic complications during their hospitalization. Feeding intolerance was similarly associated with poor outcomes including longer ICU stay (median [IQR] 21.5 [14-30] vs. 15 [9-22] days, P < 0.001), overall hospitalization time (median [IQR] 30.5 [19-42] vs. 24 [15-35], P < 0.001) and in-hospital mortality (33.9% vs. 16.1%, P < 0.001). Feeding intolerance was independently associated with an increased risk of death (HR 3.32; 95% CI 1.97-5.6).Conclusions Feeding intolerance is a frequently encountered complication in critically ill COVID-19 patients in a large tertiary care experience and is associated with poor outcomes.
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Enteral feeding intolerance is closely associated with worse clinical outcomes, such as inadequate nutrition, fewer ventilator-free days, longer ICU and hospital stays, and higher mortality, in critically ill patients.
“Previous studies have shown that EFI is closely associated with worse clinical outcomes, such as inadequate nutrition, fewer ventilator-free days, longer ICU and hospital stays, and higher mortality, emphasizing the importance of carefully monitoring EFI during EN feeding in critically ill patients [9-11].”
From The impact of enteral feeding intolerance on the prognosis of patients with septic shock in South Korea (2025) · cites this paper as [10]
The Results (§3.3; page not provided) report longer intubation and hospitalization, higher mortality, and other complications among feeding-intolerant patients; the Introduction (§1) says feeding intolerance impedes enteral nutrition. The study concerns critically ill patients with COVID-19, not critically ill patients generally, and it reports longer intubation rather than ventilator-free days. (LLM, conf=0.86)
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Enteral nutrition responsiveness in critically ill patients: An expert commentary
Patel, J. J., Taylor, B., Gibbs, K. W., Martindale, R. G., Nagrebetsky, A., Rice, T. W., & McClave, S. A. (2026) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.70128
- Authors
- Liu, R., Paz, M., Siraj, L., Boyd, T., Salamone, S., Lite, T.-L. V., Leung, K. M., Chirinos, J. D., Shang, H. H., Townsend, M. J., Rho, J., Ni, P., Ranganath, K., Violante, A. D., Zhao, Z., Silvernale, C., Ahmad, I., Krasnow, N. A., Barnett, E. S., Harisinghani, M., Kuo, B., Black, K. E., & Staller, K.
- Affiliations
- Harvard University (US)
- North Shore Medical Center (US)
- Corresponding author
- Staller, Kyle
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2022-12
- Volume
- 41
- Issue
- 12
- Pages
- 3069-3076
- ISSN
- 0261-5614 (ISSN-L)
- PMC
- PMC8007186
- OpenAlex
- W3145235885
- Cited by
- 54
- References
- 36
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 9 · 2023: 23 · 2022: 9 · 2021: 4
- FWCI
- 7.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Takeda Pharmaceuticals U.S.A.
- National Institutes of Health (NIDDK K23DK12094501A1)
- Shire
- National Institute of General Medical Sciences (T32GM007753)
- AstraZeneca
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- feeding intolerance, COVID-19 pandemic, critically ill patients, enteral nutrition, gastric residual volume, abdominal distension, vomiting, intubation time, obesity, ICU complications, in-hospital mortality, intensive care unit
- MeSH terms
- COVID-19, Adult, Enteral Nutrition, Humans, Infant, Newborn, Intensive Care Units, Critical Illness, Hospital Mortality
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