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Initial nutritional management during noninvasive ventilation and outcomes: a retrospective cohort study
Nicolas Terzi1,2, Michael Darmon3, Jean Reignier4
1INSERM, U1042, Université Grenoble-Alpes, HP2, F-38000, Grenoble, France. nterzi@chu-grenoble.fr.
Critical Care (London, England)
|December 1, 2017
Summary
Many patients on noninvasive ventilation (NIV) are not fed, but this lack of nutrition did not increase mortality. Further research is needed to determine the optimal nutritional support for patients receiving NIV.
Area of Science:
- Critical Care Medicine
- Nutritional Science
- Respiratory Medicine
Background:
- Patients on noninvasive ventilation (NIV) for acute respiratory failure often cannot eat, leading to fasting or nutritional support.
- Maintaining good nutritional status is crucial for improving patient outcomes.
- This study describes nutritional management in patients starting first-line NIV and assesses its association with outcomes.
Purpose of the Study:
- To describe the nutritional management of patients initiating first-line noninvasive ventilation (NIV).
- To evaluate the association between nutritional management strategies and patient outcomes, including mortality and need for invasive mechanical ventilation.
Main Methods:
- An observational retrospective cohort study was conducted using data from a prospective database across 20 French intensive care units.
- Adult medical patients requiring NIV for over two consecutive days were included.
- Patients were categorized into four groups based on nutritional support during the initial two days of NIV: no nutrition, enteral nutrition, parenteral nutrition only, or oral nutrition only.
Main Results:
- Out of 1075 eligible patients, 57.9% received no nutrition, 2.6% received enteral nutrition, 6.9% received parenteral nutrition only, and 32.7% received oral nutrition only.
- After adjusting for confounders, enteral nutrition was linked to increased 28-day mortality (adjusted HR, 2.3) and a higher likelihood of requiring invasive mechanical ventilation (adjusted HR, 2.1).
- Enteral nutrition was also associated with fewer ventilator-free days by day 28 (adjusted RR, 0.7).
Conclusions:
- Nearly 60% of patients on NIV experienced fasting or underfeeding during the first two days of treatment.
- Lack of feeding or underfeeding was not significantly associated with increased mortality in this cohort.
- The optimal route and strategy for nutritional support in patients receiving noninvasive ventilation require further investigation.
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