This current proposal evaluates the Longitudinal Energy Expenditure and Metabolic Effects in Patients with COVID-19 (LEEP-COVID) to understand, guide and optimize our metabolic and nutritional care of these high risk patients. As no data exist for the metabolic effects of COVID-19 patients, this data is urgently needed and essential to assist in the care of COVID-19 patients worldwide. We are uniquely positioned at Duke to perform this research, as we are the only US center with 2 of the FDA-approved devices in existence currently capable of collecting this vital data to guide the care of COVID-19 patients worldwide.
Currently, no longitudinal data exist describing the metabolic and cardiac effects of
SARS-CoV-2 (COVID-19) infection. This data is urgently needed to assist in care and promote
recovery of COVID-19 patients worldwide, and elderly patients who are at higher risk due to
increased age, pre-existing risk factors (frailty, sarcopenia, malnutrition), and co-morbid
conditions. Further, new pathologies such as COVID-19-related cardiac dysfunction must be
described and rapidly identified. Our innovative measurements will provide direct
non-invasive assessments of the effect of COVID-19 infection on key measures including energy
expenditure, substrate utilization, muscle mass, cardiac function, mitochondrial function,
and body composition. In addition, we will be able to provide objective data on key recovery
intervention requirements including energy/nutritional requirements, effects of nutrition and
rehabilitation efforts on muscle mass and energy state, and recovery of cardiac, muscle
function.
Study Questions: We propose to evaluate longitudinal metabolic and cardiac pathophysiology in
patients with COVID-19 to understand, guide and optimize our metabolic clinical care during
acute hospitalization. Further, this data will be essential in providing objective data to
guide physical recovery interventions including nutrition delivery and physical therapy to
ensure functional recovery of COVID-19 patients.
We hypothesize: 1) COVID-19 will lead to significant, EE/metabolic changes, systemic
mitochondrial dysfunction, significant muscle wasting and loss of function throughout the
course of illness and during recovery. We hypothesize metabolic needs will initially decrease
in acute illness and subsequently increase as patients transition from the acute phase of
COVID illness to recovery phases. This data will guide nutrition and metabolic/clinical care
in all phases of COVID-19 care where, for example, over-and under-feeding may pose risk to
patient outcome. We hypothesize loss of muscle mass and physical function occurring in
COVID-19 will significantly affect nutritional/rehabilitative/recovery of function/QoL needs
and requires addressing to personalize care to optimize clinical and functional recovery
efforts in older COVID-19 patients.
We believe longitudinal detailed indirect calorimetry with the innovative new Q-NRG device,
cardiac assessment, body composition, and muscle and ultrasound measures in COVID-19 patients
will play a key role in understanding and treating COVID-19 infection by providing objective
data on the metabolic, cardiac, volume/fluid status, and nutrition needs of COVID-19 patients
to the bedside clinician. This will increase our understanding of the pathophysiology of
COVID-19 and the ability of clinical teams to optimize care and patient outcomes. These
urgently needed data will lead to key advances in the clinical care of COVID-19 patients
worldwide.
Device: Q-NRG Metobolic Cart Device
COVID-19 ICU patients will be measured using the Q-NRG device for up to 30 mins. These measurements will take place every other day while the patients are in the ICU. Then they will occur a minimum of 3 times a week until discharge.
Device: MuscleSound Ultrasound
COVID-19 ICU patients will have muscle mass, muscle glycogen, and muscle quality measured at rectus femoris (leg), intercostal, and temporal muscle. These measurements will take place every other day while the patients are in the ICU. Then they will occur a minimum of 3 times a week until discharge.
Other Name: Muscle Mass Ultrasound
Device: Multifrequency Bioimpedance Spectroscopy
COVID-19 ICU patients will have body composition and phase angle measured using Multifrequency Bioimpedance Spectroscopy. These measurements will take place every other day while the patients are in the ICU. Then they will occur a minimum of 3 times a week until discharge.
Other Name: InBody S10 BIA
Inclusion Criteria:
- Critically ill COVID-19 patients greater or equal to 18 years of age patients
requiring mechanical ventilation for > 48 hours who are admitted to Duke
Surgical/Trauma ICU, Medical ICU, Cardiothoracic ICU, and Neuro ICU from admission to
hospital discharge
- Patients must be enrolled within 72 hours of ICU admission
- Control: non-COVID-19 respiratory failure patients requiring mechanical ventilation >
48 h receiving similar ICU standards of care at Duke
Exclusion Criteria:
- Age less than 18 years old
- Fraction of inhaled oxygen (FIO2) > 70%
- Positive end expiratory pressure (PEEP) > 10cmH2O
- Peak ventilatory pressure > 30cmH20
- Presence of air leaks from thoracic drain tube
- Changes in vasoactive agent dose (>20%, <1 hr before or during IC)
- Agitation or change in sedative/analgesic dose (>20%, <1 hr before and/or during IC)
- Change in body temperature (>0.5°C, <1 hr before and/or during IC)
- Expected duration of ICU stay < 24 hours
- Expected survival of the patient < 24 hours
Duke University Medial Center
Durham, North Carolina, United States
Paul E Wischmeyer, MD, EDIC, FASPEN, FCCM, Principal Investigator
Duke University