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Observational Study
. 2017 Nov 29;21(1):293.
doi: 10.1186/s13054-017-1867-y.

Initial nutritional management during noninvasive ventilation and outcomes: a retrospective cohort study

Nicolas Terzi  1   2 , Michael Darmon  3 , Jean Reignier  4 , Stéphane Ruckly  5   6 , Maïté Garrouste-Orgeas  7 , Alexandre Lautrette  8 , Elie Azoulay  9 , Bruno Mourvillier  6   10 , Laurent Argaud  11 , Laurent Papazian  12 , Marc Gainnier  13 , Dan Goldgran-Toledano  14 , Samir Jamali  15 , Anne-Sylvie Dumenil  16 , Carole Schwebel  17   18 , Jean-François Timsit  6   10 ; OUTCOMEREA study group
Collaborators, Affiliations
Observational Study

Initial nutritional management during noninvasive ventilation and outcomes: a retrospective cohort study

Nicolas Terzi et al. Crit Care. .

Abstract

Background: Patients starting noninvasive ventilation (NIV) to treat acute respiratory failure are often unable to eat and therefore remain in the fasting state or receive nutritional support. Maintaining a good nutritional status has been reported to improve patient outcomes. In the present study, our primary objective was to describe the nutritional management of patients starting first-line NIV, and our secondary objectives were to assess potential associations between nutritional management and outcomes.

Methods: Observational retrospective cohort study of a prospective database fed by 20 French intensive care units. Adult medical patients receiving NIV for more than 2 consecutive days were included and divided into four groups on the basis of nutritional support received during the first 2 days of NIV: no nutrition, enteral nutrition, parenteral nutrition only, and oral nutrition only.

Results: Of the 16,594 patients admitted during the study period, 1075 met the inclusion criteria; of these, 622 (57.9%) received no nutrition, 28 (2.6%) received enteral nutrition, 74 (6.9%) received parenteral nutrition only, and 351 (32.7%) received oral nutrition only. After adjustment for confounders, enteral nutrition (vs. no nutrition) was associated with higher 28-day mortality (adjusted HR, 2.3; 95% CI, 1.2-4.4) and invasive mechanical ventilation needs (adjusted HR, 2.1; 95% CI, 1.1-4.2), as well as with fewer ventilator-free days by day 28 (adjusted relative risk, 0.7; 95% CI, 0.5-0.9).

Conclusions: Nearly three-fifths of patients receiving NIV fasted for the first 2 days. Lack of feeding or underfeeding was not associated with mortality. The optimal route of nutrition for these patients needs to be investigated.

Keywords: Acute respiratory failure; Intensive care unit; Noninvasive mechanical ventilation; Nutrition; Pneumonia.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Clermont-Ferrand Hospital institutional review board (Clinical Investigation Center Ethics Committee [CECIC] Clermont-Ferrand IRB number 5891, reference 2007-16), which waived the need for written informed consent of the participants, in accordance with French legislation on noninterventional studies.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of the study. ICU Intensive care unit, NIV Noninvasive ventilation
Fig. 2
Fig. 2
Impact of nutrition group on outcome. ICU Intensive care unit, sHR Subdistribution hazard ratio, RR Relative risk
See this image and copyright information in PMC

References

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