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The Implementation of a Feeding Protocol in Patients With Noninvasive Ventilation Improves Enteral Nutrition: The
Javier Rodriguez-Fanjul1, Clara Sorribes Ortí2, Ana Santos Monton2
1Pediatric Intensive Care Unit, Pediatric Service, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, and Institut d'Investigació Germans Trias i Pujol, Badalona, Spain.
Insights
Implementing a standardized enteral nutrition (EN) protocol for children with bronchiolitis on biphasic positive airway pressure (BiPAP) significantly reduced EN initiation time and time to reach calorie goals, with no adverse effects observed.
Area of Science:
- Pediatric critical care
- Respiratory medicine
- Clinical nutrition
Background:
- Bronchiolitis is a common pediatric respiratory illness.
- Children with bronchiolitis often require respiratory support, including biphasic positive airway pressure (BiPAP).
- Optimal enteral nutrition (EN) strategies for these patients are not well-defined.
Purpose of the Study:
- To evaluate the impact of a standardized enteral nutrition (EN) protocol on children with bronchiolitis receiving biphasic positive airway pressure (BiPAP) support.
- To decrease the mean time to initiation of EN by 50% after the start of BiPAP.
- To assess secondary outcomes including time to reach target calories, BiPAP duration, and adverse events.
Main Methods:
- A quality improvement project comparing two periods: before (n=48) and after (n=54) protocol implementation.
- Patients with bronchiolitis on BiPAP received EN via nasogastric tubes.
- A stakeholder-developed algorithm guided EN initiation and advancement.
Main Results:
- Median time to EN initiation decreased from 18 to 6 hours (P < 0.05).
- Median time to reach target calories (100 kcal/kg/d) decreased from 103 to 48 hours (P < 0.05).
- No significant difference in BiPAP duration or documented adverse events, including aspiration.
Conclusions:
- A standardized EN pathway for pediatric patients on BiPAP accelerates nutrition delivery.
- Faster EN initiation and achievement of caloric goals were observed without increased adverse events.
- Findings support considering more aggressive enteral feeding in noninvasively ventilated pediatric patients.
Purpose:
There is limited evidence to guide the treatment of enteral nutrition (EN) for children with bronchiolitis who receive biphasic positive airway pressure (BiPAP) support.
Methods:
This quality improvement project included patients with bronchiolitis who were supported by BiPAP ventilation. An algorithm to increase EN treatment in those patients was created by stakeholders. Two periods of time were compared: group 1 (January 2023 to August 2023) without nutrition implementation protocol vs group 2 (September 2023 to February 2024) after the protocol was implemented. EN was provided via nasogastric tubes. The project aim was to decrease the mean time to initiation of EN by 50% after the start of BiPAP. Secondary end points were time to reach target calories (100 kcal/kg/d), BiPAP total duration, and the proportion of patients with adverse effects.
Results:
For the 102 included patients (48 before and 54 after BiPAP ventilation), the median time to the start of EN decreased from 18 (8-26) hours to 6 (2-8) hours (P < 0.05) Median time to reach calorie goal decreased from 103 (85-120) hours to 48 hours (36-60) (P < 0.05). There were no differences in noninvasive ventilation mean duration. No episodes of aspiration or other adverse effects were documented.
Conclusions:
The implementation of a standardized pathway for EN in patients with BiPAP was associated with faster initiation of EN and a shorter time to reaching caloric goals without any observed adverse events. Although our sample was small, the findings suggest that more aggressive enteral feeding should be considered in patients receiving noninvasive ventilation.
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