Kritika Subramanian1, Gary Brandeis2. 1. Department of Molecular Imaging and Therapeutics, Weill Cornell Medicine, New York, NY, USA. Electronic address: krs9089@nyp.org. 2. Division of Geriatrics, Department of Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY, USA.
Dear Editor,We were quite certainly pleased with the letter sent by Quintero et al. regarding our work entitled “Effect of parenteral nutrition in oxygen escalation/de-escalation in SARS-CoV-2 infected patients who are pre-intubation: A multicenter, observational study [1].” Many important factors, including limitations on the research methods and techniques, were brought up by Quintero et al. We felt it important to bring up a few matters to clarify the purpose of our study and our intention with the publication. As we mentioned in the conclusion, our point was not to suggest parenteral nutrition must be administered in patients who are on non-invasive ventilation (NIV), but instead to demonstrate that nutritional intake is important in the care of patients with SARS-CoV-2 and poor nutritional intake may contribute to clinical deterioration (as defined by the oxygen escalation/de-escalation).We acknowledge the many limitations in the study. We also appreciate the comments proposed by Quintero et al. regarding other enteral feeding tools which could be considered. We congratulate the authors on their publication of a novel nasogastric tube adaptor; however it was not a device available for consideration at the time of our study [2]. Reviewing the details of the adaptor, tube feeding while in the prone position, that was the standard of care for hypoxic patients with SARS-CoV-2, would be problematic.We describe in the third paragraph of the introduction the reasoning behind selecting parenteral nutrition in the patients who were placed on NIV. The criteria for initiating NIV was an oxygen saturation below 92% for all patients. However for the purposes of our study, this did not introduce a bias because all patients were on noninvasive ventilation at the start of the study.Although a cost analysis would be helpful, we did not employ enteral nutrition in our study, and it therefore was not performed. We hope this response helps clarify the purpose and context of the study.