In 2020 the world was sieged by a pandemic caused by the novel coronavirus SARS-COV-2, which was responsible for the new coronavirus disease (COVID-19). This outbreak demanded a considerable number of intensive care unit (ICU) beds, hospital resources,1 and healthcare professionals, aimed to provide adequate treatment and organ support for ICU patients.2 SARS-COV 2 infected patients with respiratory failure due to severe pneumonia and acute respiratory distress syndrome (ARDS) who are admitted to the ICU exhibit severe systemic inflammation, hypermetabolism, and hypercatabolism, which expose these patients to high risk of malnutrition and sarcopenia.3 Moreover, these patients have increased energy expenditure, which is due to ventilatory workload, mechanical ventilation requirement, and the development of multiorgan failure.3 Recently, we have found that COVID-19 ICU patients are at high risk of malnutrition, and those who were previously malnourished showed a significantly higher overall mortality.4 Moreover, our recently published study found that malnourished ICU patients showed worse clinical outcomes compared with well-nourished COVID-19 critically ill patients.4

In 2020, the Metabolic and Nutritional Support Committee (COSONUME) and the Dietician Section (CALINU), both sections belonging to the Argentine Society of Intensive Care (SATI), developed a summary of clinical recommendations to provide the best nutritional therapy for COVID-19 ICU patients.5 This concise guideline, among others,6, 7, 8, 9 is a basic framework of evidence mostly derived from observational and retrospective data, as well as data from non-COVID-19 patients.5

In the SATI guideline, we proposed that all ICU patients staying for more than 48 h in the ICU should be considered at risk for malnutrition. In addition, a hypocaloric nutrition strategy over the early phase of critical illness, defined as less than 70% of the estimated requirements, was also suggested.5 Moreover, with the aim to determine the caloric requirement we proposed the use of predictive equations, as indirect calorimetry is not commonly available in most Argentine ICUs. Finally, after the seventh day of the ICU stay, we recommended progressing caloric delivery to up to 100% of energy requirements.5

Regarding protein intake, in agreement with the updated ESPEN guidelines,9 we suggested a daily dose of ≥1.3 g/kg, which should be administered progressively. This intervention showed improvement mainly in the survival of elderly and frail critically ill patients.10

Therefore, this study aimed to evaluate the caloric and protein intake in the first 14 days in critically ill COVID-19 patients. The secondary outcome aimed to evaluate factors that could affect reaching a caloric intake higher than 25 kcal/kg/day and protein intake higher than 1.3 g/kg/day, although there is recent conflicting evidence.11, 12, 13, 14, 15