Enteral Feeding of Children on Noninvasive Respiratory Support: A Four-Center European Study*

Tume, Lyvonne N; Eveleens, Renate; Mayordomo-Colunga, Juan; López, Jorge; Verbruggen, Sascha; Fricaudet, M.; Smith, Caroline M.; Cusco, Mireia Garcia; Latten, Lynne; Valla, Frédéric V.

doi:10.1097/pcc.0000000000002602

Cited by 17 publications

(28 citation statements)

References 17 publications

(33 reference statements)

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“…Pediatric studies have shown benefits of early nutrition, in both mechanically ventilated and non-invasively supported patients [ 16 , 28 ]. In fact, a recently published retrospective study in four European PICUs reached similar conclusions to ours, reporting safety and tolerance of early enteral nutrition in patients managed on NRS [ 20 ]. However, we now need larger scale prospective studies specifically designed to examine the effects of early enteral nutrition on pediatric intubation rates, ventilator-free-days, organ failure-free-days, and overall length of PICU and hospital stay.…”

Section: Discussionsupporting

confidence: 87%

“…Despite data to the contrary, providers often cite safety concerns for delaying EN on NRS [ 17 , 18 ]. Commonly cited reasons include: (a) the potential for the patient’s status to worsen to requiring mechanical ventilation; (b) nasogastric tubes interfering with optimal NRS mask seal; (c) exacerbating respiratory failure from breaks to allow oral feeds; and (d) concerns surrounding aspiration of gastric contents during feeds [ 19 , 20 ]. Notably, pediatric patients often require sedation to tolerate NRS, which further raises the concern for aspiration from relaxation of airway protective reflexes [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

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A Retrospective Analysis of Feeding Practices and Complications in Patients with Critical Bronchiolitis on Non-Invasive Respiratory Support

et al. 2021

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Limited data exist regarding feeding pediatric patients managed on non-invasive respiratory support (NRS) modes that augment oxygenation and ventilation in the setting of acute respiratory failure. We conducted a retrospective cohort study to explore the safety of feeding patients managed on NRS with acute respiratory failure secondary to bronchiolitis. Children up to two years old with critical bronchiolitis managed on continuous positive airway pressure, bilevel positive airway pressure, or RAM cannula were included. Of the 178 eligible patients, 64 were reportedly nil per os (NPO), while 114 received enteral nutrition (EN). Overall equivalent in severity of illness, younger patients populated the EN group, while the NPO group experienced a higher incidence of intubation. Duration of stay in the pediatric intensive care unit and non-invasive respiratory support were shorter in the NPO group, though intubation eliminated the former difference. Within the EN group, ninety percent had feeds initiated within 48 h and 94% reached full feeds within 7 days of NRS initiation, with an 8% complication and <1% aspiration rate. Reported complications did not result in escalation of respiratory support. Notably, a significant improvement in heart rate and respiratory rate was noted after feeds initiation. Taken together, our study supports the practice of early enteral nutrition in patients with critical bronchiolitis requiring NRS.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

A Retrospective Analysis of Feeding Practices and Complications in Patients with Critical Bronchiolitis on Non-Invasive Respiratory Support

et al. 2021

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“…However, only 10.8% fed per oral, only 33.2% were on BIPAP, and it is unclear if there were any children admitted with SA. 20 Even though 81.4% of cases on BIPAP in our study were on EN within 24 hours, and 100% eventually received full EN while still on BIPAP, it was noted that the time to achieve both was longer in the BIPAP group than the simple mask group. This is intuitive and can be attributed to increased severity of illness as evidenced by higher asthma scores, longer requirement of continuous inhaled albuterol, and use of adjunctive therapy in the former group.…”

Section: Discussionmentioning

confidence: 53%

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

Komeswaran

Khanal

Powell

et al. 2021

J Pediatr Intensive Care

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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.

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“…[14, 24] In fact, a recently published retrospective pediatric study in 4 European PICUs reached similar conclusions to ours, reporting safety and tolerance of early enteral nutrition in patients managed on NRS. [18]…”

Section: Discussionmentioning

confidence: 99%

“…[15, 16] Commonly cited reasons include: a) the potential for the patient’s status to worsen potentially requiring mechanical ventilation; b) nasogastric tubes interfering with optimal NRS mask seal; c) exacerbating respiratory failure from breaks to allow oral feeds; and d) concerns surrounding aspiration of gastric contents during feeds. [17, 18] Notably, pediatric patients often require sedation to tolerate NRS, which further raises the concern for aspiration from relaxation of airway protective reflexes. [19, 20] Overall, there lacks consensus on the risk-benefit of feeding patients on NRS.…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Analysis of Feeding Practices and Complications in Patients with Critical Bronchiolitis on Non-invasive Respiratory Support

Lenihan

Ramos

Nemec

et al. 2021

Preprint

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Limited data exist regarding feeding pediatric patients managed on non-invasive respiratory support (NRS) modes that augment oxygentation and ventilation in the setting of respiratory failure. We conducted a retrospective cohort study to explore the safety of feeding patients managed on NRS with acute respiratory failure secondary to bronchiolitis. Children up to 2 years old with critical bronchiolitis managed on RAM, CPAP, or BiPAP were included. Of the 178 eligible patients, 64 were reportedly NPO while 114 were fed (EN). Overall equivalent in severity of illness, younger patients populated the EN group, while the NPO group experienced a higher incidence of intubation. Duration of PICU stay and NRS were shorter in the NPO group, though intubation eliminated the former difference. Within the EN group, ninety percent had feeds initiated within 48 hours and 94% reached full feeds within 7 days of NRS initiation, with an 8% complication and <1% aspiration rate. Reported complications did not result in escalation of respiratory support. Notably, a significant improvement in heart rate and respiratory rate was noted after feeds initiation. Taken together, our study supports the practice of early enteral nutrition in patients with critical bronchiolitis requiring non-invasive respiratory support.

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Enteral Feeding of Children on Noninvasive Respiratory Support: A Four-Center European Study*

Abstract: Objective: To explore enteral feeding practices and the achievement of energy targets in children on Non-invasive respiratory support (NRS), in four European Pediatric Intensive Care Units (PICUs).

Cited by 17 publications

References 17 publications

A Retrospective Analysis of Feeding Practices and Complications in Patients with Critical Bronchiolitis on Non-Invasive Respiratory Support

A Retrospective Analysis of Feeding Practices and Complications in Patients with Critical Bronchiolitis on Non-Invasive Respiratory Support

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

A Retrospective Analysis of Feeding Practices and Complications in Patients with Critical Bronchiolitis on Non-invasive Respiratory Support

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