Nutrition during noninvasive respiratory support

Area of Science:

• Critical Care Medicine
• Respiratory Therapy
• Nutritional Science

Background:

• Noninvasive ventilation (NIV) and high flow nasal cannula (HFNC) are widely used for respiratory failure, especially post-COVID-19.
• These respiratory support methods can interfere with a patient's ability to eat, creating a "breath or eat" dilemma.
• Malnutrition is a significant concern for patients requiring respiratory support.

Purpose of the Study:

• Identify patients at risk of malnutrition requiring medical nutritional therapy.
• Understand the mechanisms of NIV and HFNC devices.
• Provide adapted nutritional guidance for patients on NIV or HFNC.

Main Methods:

• Review of current literature on respiratory support and nutritional challenges.
• Assessment of malnutrition risk using validated tools (e.g., Global Leadership Initiative for Malnutrition).
• Analysis of the impact of NIV and HFNC on swallowing and feeding.

Main Results:

• The Global Leadership Initiative for Malnutrition is validated for ICU patients on NIV.
• Many patients receiving NIV are underfed.
• HFNC may worsen dysphagia, while NIV might improve swallowing reflexes.
• New technologies can enhance the safety and efficacy of enteral feeding.

Conclusions:

• Patients requiring NIV present significant nutritional challenges.
• Key steps include assessing nutritional status and dysphagia.
• Choosing appropriate respiratory support and adapting nutritional therapy (oral, enteral, parenteral) are essential.