The implementation of a feeding protocol in patients with Non INvasive
ventilation improves ENteral nutrition. The NIVEN study
Abstract
Purpose: Children with bronchiolitis admiteed to the pediatric intensive
care unit (PICU) for acute respiratory failure may require respiratory
support with non-invasive ventilation (NIV). Enteral nutrition (EN) is
associated with a reduction in hospital stay. Even so, guidelines do not
specify on how to initiate, increase and maintain EN in these patients.
Methods This was a prospective interventional study. Inclusion criteria
were patients with bronchiolitis under NIV. A multidisciplinary team
created an algorithm to improve EN for critically ill patients with
bronchiolitis in need of NIV. In order to assess the protocol
implementation, two periods of time were compared: Group 1: without
nutrition implementation protocol vs Group 2, once the protocol was
implemented. The project aim was to decrease the mean time to EN
initation by 50% after the start of NIV. Secondary endpoints were time
to reach target calories ( 100 kcal/kg/day), NIV duration, and % of
patients with adverse effects. Results Hundred two patients were
included in this study. In group 1, Forty eight and 54 in group 2.
Statistically significant differences were detected in the main outcome.
The mean time until the start of EN decreased from 18.5 hours to 6 hours
(p<0.05) Median time to reach calorie goal decreased from
103.5 hours to 48.5 hours (p<0.05). No differences were
dettected in other outcomes. Conclusions The implementation of a
standardized route for EN in patients with NIV allow a decrease in the
time of the start feeds and the time to the goal of caloric enteral
nutrition.