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Enteral Feeding for Children on Bilevel Positive Pressure Ventilation for Status Asthmaticus
Kavipriya Komeswaran1, Aayush Khanal1, Kimberly Powell1
1Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, Illinois, United Sates.
Insights
Enteral nutrition is safe and effective for children with status asthmaticus, even those on bilevel positive airway pressure (BIPAP) ventilation. This study found no complications, demonstrating successful feeding practices in a pediatric intensive care unit.
Area of Science:
- Pediatric critical care medicine
- Pediatric respiratory medicine
- Clinical nutrition
Background:
- Status asthmaticus in children requires intensive care, with nutritional support being crucial for recovery.
- Enteral nutrition is the preferred route for nutritional support in critically ill children.
- Noninvasive ventilation, such as bilevel positive airway pressure (BIPAP), is commonly used in pediatric status asthmaticus.
Purpose of the Study:
- To evaluate the safety and efficacy of enteral nutrition practices in pediatric patients admitted with status asthmaticus.
- To compare enteral nutrition initiation and advancement in patients on BIPAP versus those on simple mask ventilation.
- To identify any complications associated with enteral feeding in this patient population.
Main Methods:
- Retrospective data analysis of 315 pediatric intensive care unit patients admitted with status asthmaticus.
- Categorization of patients based on ventilation support: bilevel positive airway pressure (BIPAP) or simple mask.
- Analysis of enteral nutrition initiation time, advancement to full feeds, and incidence of complications.
Main Results:
- Enteral nutrition was initiated and advanced in all patients, with 99.3% receiving oral feeds.
- Patients on BIPAP had a longer median time to initiation of feeds (11.0 hours) and full feeds (23.0 hours) compared to the simple mask group (4.3 and 12.0 hours, respectively).
- Despite being sicker, patients on BIPAP tolerated enteral nutrition without aspiration pneumonia or need for invasive mechanical ventilation.
Conclusions:
- Enteral nutrition is a safe and effective method for supporting children with status asthmaticus, including those requiring noninvasive ventilation.
- Nutritional support can be successfully implemented even in the acute phase of severe asthma exacerbations.
- Further research could explore optimizing feeding protocols for children on noninvasive ventilation during 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.
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