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Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Research

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

Authors: Nicolas Terzi, Michael Darmon, Jean Reignier, Stéphane Ruckly, Maïté Garrouste-Orgeas, Alexandre Lautrette, Elie Azoulay, Bruno Mourvillier, Laurent Argaud, Laurent Papazian, Marc Gainnier, Dan Goldgran-Toledano, Samir Jamali, Anne-Sylvie Dumenil, Carole Schwebel, Jean-François Timsit, for the OUTCOMEREA study group

Published in: Critical Care | Issue 1/2017

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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.
Appendix
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Metadata
Title
Initial nutritional management during noninvasive ventilation and outcomes: a retrospective cohort study
Authors
Nicolas Terzi
Michael Darmon
Jean Reignier
Stéphane Ruckly
Maïté Garrouste-Orgeas
Alexandre Lautrette
Elie Azoulay
Bruno Mourvillier
Laurent Argaud
Laurent Papazian
Marc Gainnier
Dan Goldgran-Toledano
Samir Jamali
Anne-Sylvie Dumenil
Carole Schwebel
Jean-François Timsit
for the OUTCOMEREA study group
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1867-y

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