Enteral Feeding for Children on Bilevel Positive Pressure Ventilation for Status Asthmaticus

Abstract

A retrospective data analysis was conducted to evaluate enteral nutrition practices for children admitted with status asthmaticus in a single-center pediatric intensive care unit. Of 406 charts, 315 were analyzed (63% male); 135 on bilevel positive airway pressure ventilation (BIPAP) and 180 on simple mask. Overall median age and weight were 6.0 (interquartile range [IQR]: 6.0) years and 24.8 (IQR: 20.8) kg, respectively. All children studied were on full feeds while still on BIPAP and simple mask; 99.3 and 100% were fed per oral, respectively. Median time to initiation of feeds and full feeds was longer in the BIPAP group, 11.0 (IQR: 20) and 23.0 hours (IQR: 26), versus simple mask group, 4.3 (IQR: 7) and 12.0 hours (IQR: 15), p = 0.001. The results remained similar after adjusting for gender, weight, clinical asthma score at admission, use of adjunct therapy, and duration of continuous albuterol. By 24 hours, 81.5% of patients on BIPAP and 96.6% on simple mask were started on feeds. Compared with simple mask, patients on BIPAP were sicker with median asthma score at admission of 4 (IQR: 2) versus 3 (IQR: 2) on simple mask, requiring more adjunct therapy (80.0 vs. 43.9%), and a longer median length of therapy of 41.0 (IQR: 41) versus 20.0 hours (IQR: 29), respectively, p = 0.001. There were no complications such as aspiration pneumonia, and none required invasive mechanical ventilation in either group. Enteral nutrition was effectively and safely initiated and continued for children admitted with status asthmaticus, including those on noninvasive bilevel ventilation therapy.

A Retrospective Study of Complications of Enteral Feeding in Critically Ill Children on Noninvasive Ventilation

“…The incidence of respiratory and gastric complications in pediatric patients enterally fed while on NIV is variable [ 10 , 11 , 22 , 26 ]. Such differences may arise from the important variation in the definition of complication, the population studied, and the variable clinical practice between centers [ 3 , 10 , 15 , 22 , 23 , 24 ].…”

“…The findings here are similar to those described by Tume and colleagues in a cohort of children requiring NIV, predominantly HHFNC, where respiratory complications occurred in 12.3% of children and were mainly non-severe, with 1.5% of patients suffering from a pulmonary aspiration [ 24 ]. Another recent study including asthmatic patients on BiPAP showed no complications secondary to EN [ 26 ]. Studies investigating respiratory deteriorations with enteral nutrition evaluate for aspirations or surrogates for gastric intolerance such as vomiting or gastric residual volume.…”

“…Lastly, this study showed that the majority of our patients received enteral nutrition while on NIV as recommended by North American and European guidelines with minimal effect on rates of respiratory complications [ 12 , 13 ]. Multiple studies have demonstrated the large variability in EN initiation and titration between centers in critically ill adults and children [ 11 , 15 , 20 , 22 , 24 , 26 ]. In two recent retrospective cohort studies in children, NIV was identified as one of the factors independently associated with delayed EN initiation [ 10 , 14 ].…”

“…Although data are limited, the available evidence suggests variability in the incidence of respiratory (0–12%) [ 10 , 11 , 22 ] and gastric complications (4.8–20%) [ 3 , 23 ] when providing EN to pediatric patients on NIV [ 26 ]. The objective of this study was to evaluate the safety of enteral feeds in children requiring NIV for acute respiratory failure.…”