A higher rate of gastrointestinal complications has been shown in COVID-19 patients admitted to the intensive care unit than their counterparts without COVID-19. Ogilvie’s syndrome or acute colonic pseudo-obstruction is described as colonic distension without mechanical obstruction, usually caused by infections, opioid use, renal dysfunction, and electrolyte imbalance. We report a patient with Ogilvie’s syndrome probably secondary to COVID-19. The patient was a 51-year-old man diagnosed as category 5 COVID-19, requiring intensive care treatment and mechanical ventilation. He developed transverse colonic perforation following large bowel dilatation, for which laparotomy and colectomy were done. Unfortunately, he succumbed to death due to intrabdominal sepsis with multiorgan failure. Possible pathogenesis of ileus in severe COVID-19 infection includes viral-induced autonomic nervous system dysfunction, viral-induced gut inflammation mediated by ACE-2 receptors located on the enterocytes, and ischaemic endothelialitis.

Introduction: This study aimed to compare the nutritional characteristics and clinical outcomes among critically ill patients with diabetes (DM) and without diabetes (WDM). Methods: Mechanically ventilated, critically ill patients who were admitted into the intensive care unit (ICU) within 48 hours and remained in ICU ≥72 hours were prospectively recruited and followed for up to 12 days. They were stratified to DM or WDM, depending on their diabetes status at ICU admission and comparison were made for nutritional characteristics and clinical outcomes including 60-day mortality. Results: A total of 154 patients were included with 73 (47.4%) DM patients. In comparison to WDM, patients with DM were older, more severely ill, had higher nutritional risk and body mass index, presented with a higher blood glucose level, and required more insulin. DM was fed relatively earlier but had lower energy adequacy. They experienced more frequent EN interruption. Both groups had comparable ICU and hospital stay, ventilation support duration and mortality. In multivariable logistic regression, no association was found between diabetes status and for ICU and hospital mortality. However, There was a trend towards an increase in 60-day mortality in DM patients (Odds Ratio: 2.220, 95% Confidence Interval: 0.764-6.452; p=0.143). Conclusion: Critically ill patients with DM had higher nutritional risks, were fed relatively earlier, but with frequent EN interruption leading to lower energy adequacy than patients WDM. Diabetes status does not affect clinical outcomes.

Introduction: The limited data regarding nutrition characteristics and the delivery of critically ill patients in South Asia is intriguing. This study was conducted to investigate the nutrition characteristics and delivery in relation to 28- day mortality in mechanically ventilated patients. Methods: This prospective observational study was conducted in the intensive care unit (ICU) of the Maldives government referral hospital. Data about nutrition characteristics and delivery were collected from the ICU charts, and each patient was followed for a maximum of 28 days. Results: We recruited a total of 115 patients (mean age: 61.57±17.26 years, 52% females, mean BMI: 25.5±6.19kg/m2), of which 61 (53%) of them died within 28 days of ICU admission. Mean energy intake was 681.15±395.37 kcal per day, and mean protein intake was 30.32±18.97g per day. In the univariate logistic regression analysis, length of stay in ICU (OR = 0.950, 95% CI: 0.908 – 0.994, p = 0.027), and received intervention by a dietitian (OR = 0.250, 95% CI: 0.066 – 0.940, p = 0.040) were associated with 28-day mortality. None of the factors in the multivariate regression analysis remains significant when adjusted for sex, SOFA total score, daily energy and protein dosage. Conclusion: 28-day mortality was much higher in this study than in similar studies in South Asia, Asia and around the globe. None of the variables was significantly associated with 28-day mortality in the multivariate logistic model. However, there was a trend towards higher mortality for patients with shorter length of stay in the ICU, larger mean gastric residual volume, and no intervention by a dietitian.