Nutritional therapy for patients with respiratory hypoxemic failure without a protected airway

Nutritional therapy is challenging in patients admitted to the ICU due to acute hypoxemic respiratory failure (AHRF) and candidates for oxygen therapy through noninvasive modalities, such as noninvasive ventilation (NIV) or high-flow nasal cannulas (HFNC). Nutritional status assessment, the definition of nutritional needs, routes and modes of administration, diet types, monitoring of food tolerance, complications and safety during ICU admission, and nutrition-focused outcomes are not well established in these patients and have not been specifically addressed in international ICU guidelines. This review will focus on the nutritional treatment of patients with AHRF without airway protection admitted to an ICU.

Oral nutrition, following swallowing tests, remains the preferred route for feeding these patients. However, the prevalence of insufficient feeding remains high, especially in those receiving NIV compared to HFNC modality. Artificial nutrition is used less frequently. Finally, trophic nutrition, either orally or via a nasogastric tube (NGT), has emerged as a new modality of nutritional treatment for these patients and has been shown to be safe and feasible.

Insufficient feeding appears to be the norm in ICU patients treated for AHRF with noninvasive ventilation modalities. New approaches, protocols, guideline updates, and more high-quality studies are needed.