1
|
Crimi C, Chiaramonte R, Vignera F, Vancheri C, Vecchio M, Gregoretti C, Carlucci A, Andersen T, Cortegiani A. Effects of high-flow nasal therapy on swallowing function: a scoping review. ERJ Open Res 2024; 10:00075-2024. [PMID: 38978547 PMCID: PMC11228606 DOI: 10.1183/23120541.00075-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/28/2024] [Indexed: 07/10/2024] Open
Abstract
Background High-flow nasal therapy is widely used in patients with respiratory failure in different clinical settings, but the effect of high-flow nasal therapy on respiratory-swallow coordination is unknown. Understanding this relationship is crucial, considering the necessity for patients to maintain adequate nutrition during daytime high-flow nasal therapy. This scoping review aims to synthesise available data on the effects of high-flow nasal therapy flow rates on swallowing function and the possible risk of aspiration during treatment, focusing on knowledge and evidence gaps. Methods PubMed, Scopus, Web of Science and Google Scholar databases were searched from inception to 30 May 2023 for studies reporting data on swallowing assessment in healthy adults or patients with acute or chronic respiratory failure receiving high-flow nasal therapy. Data on study design, patients' characteristics and quality outcomes were extracted. Results Eight studies were included, four including cohorts of healthy volunteers (n=148) and four including patients with acute or chronic respiratory failure (n=151). Study designs, patient populations and quality outcome measures were heterogeneous. Two studies indicated improvement while four articles showed impairment in swallowing function during high-flow nasal therapy; two studies showed that patients' overall clinical picture and underlying medical conditions influenced swallowing-breathing coordination rather than high-flow nasal therapy per se. Conclusion This scoping review found limited and controversial evidence on the impact of high-flow nasal therapy on swallowing function. Remarkably, methods for swallowing function assessment were quite heterogeneous. Additional research is required to test the effect of high-flow nasal therapy on respiratory-swallowing coordination.
Collapse
Affiliation(s)
- Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco" University Hospital, Catania, Italy
| | - Rita Chiaramonte
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- Rehabilitation Unit, Policlinico "G. Rodolico-San Marco" University Hospital, Catania, Italy
| | - Fabio Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco" University Hospital, Catania, Italy
| | - Michele Vecchio
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- Rehabilitation Unit, Policlinico "G. Rodolico-San Marco" University Hospital, Catania, Italy
| | - Cesare Gregoretti
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy
- Fondazione "Giglio", Cefalù, Italy
| | - Annalisa Carlucci
- Department of Medicina e Chirurgia, Università Insubria Varese-Como, Como, Italy
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Tiina Andersen
- Thoracic Department, Haukeland University Hospital, Bergen, Norway
- The Department of Health and Functioning, Western Norway University of Applied Science, Bergen, Norway
| | - Andrea Cortegiani
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| |
Collapse
|
2
|
Singer P. Nutrition therapy in non-intubated patients with acute respiratory failure: a narrative review. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2024; 43:57-61. [PMID: 39082322 PMCID: PMC11305352 DOI: 10.36185/2532-1900-405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/07/2024] [Indexed: 08/10/2024]
Abstract
Objectives Non-invasive ventilation use is increasing in patients from acute respiratory failure. However, nutritional assessment and medical nutritional therapy are often missed and patients may be frequently underfed. This review evaluates the tools for nutritional screening and assessment, assesses the use of medical nutritional therapy in various techniques of non invasive ventilation and suggested tools to improve this therapy. Methods, results A review of the literature was performed to evaluate the tools available to define malnutrition and determine the energy needs of patients requiring non invasive ventilation. Energy and protein intake was assessed in 16 recent papers. High Flow Nasal Cannula Oxygen therapy and non invasive ventilation using mask were described and nutritional therapy determined in each condition. The Global Leadership International Malnutrition Assessment seems to be the best assessment to be recommended. Energy expenditure is optimally obtained by indirect calorimetry. Patients with Non invasive ventilation are even more underfed than patients receiving High Flow Nasal Cannula Oxygen therapy. Conclusions A better determination of malnutrition, a more adequate energy requirement and an improved energy and protein administration are required in patients with acute respiratory failure treated with non invasive ventilation.
Collapse
Affiliation(s)
- Pierre Singer
- Herzlia Medical Center, Herzlia, Israel
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| |
Collapse
|
3
|
Andersen TM, Bolton L, Toussaint M. Practical recommendations for swallowing and speaking during NIV in people with neuromuscular disorders. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2024; 43:62-70. [PMID: 39082323 PMCID: PMC11305350 DOI: 10.36185/2532-1900-417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 08/10/2024]
Abstract
Objectives The functions of eating, drinking, speaking, and breathing demand close coordination of the upper airway musculature which may be challenged by the long-term use of daytime non-invasive ventilation (NIV). This rapid review explores the challenges and practicalities of these interactions in people with neuromuscular disorders. Methods A search was performed on PubMed (period 2000-2023) using generic terms to refer to eating, drinking, and speaking related to people with neuromuscular disorders on NIV. A narrative approach was used to summarize the available literature. Results Our review shows only a small number of studies exist exploring the use of NIV on swallowing and speaking in people with neuromuscular disorders. We summarize study findings and provide practical advice on eating, drinking and speaking with NIV. Conclusions By understanding breathing, NIV mechanics and upper airway interactions, it is possible to optimize swallowing and speaking whilst using NIV. There is a lack of specific guidelines, and concerns regarding aspiration warrant further research and guideline development.
Collapse
Affiliation(s)
- Tiina Maarit Andersen
- Thoracic Department, Haukeland University Hospital, Bergen, Norway
- The Department of Health and Functioning, Western Norway University of Applied Science, Bergen, Norway
| | - Lee Bolton
- Speech and Language Therapy, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Trust, London, United Kingdom
| | - Michel Toussaint
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Department of Neurology, Centre de Référence Neuromusculaire, Brussels, Belgium
| |
Collapse
|
4
|
Reta-Pérez O, Colmenero-Ruiz M, Hernández-Socorro CR, Saavedra P, Maichle SF, Portugal E, Cerezo-Arias M, Sánchez Alés L, Martínez-Carmona JF, Mateu-Campos L, Lorencio-Cárdenas C, García-Miguélez A, Sosa-Durr M, San Martín-Bragado M, Ruiz-Santana S. Trophic Nutrition in ICU Patients Undergoing High-Flow Oxygen Therapy and/or Noninvasive Mechanical Ventilation: The Nutri-Trophic Study. Nutrients 2024; 16:1366. [PMID: 38732612 PMCID: PMC11085204 DOI: 10.3390/nu16091366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Enteral nutrition (EN) therapy in ICU patients requiring oxygen therapy with high-flow nasal cannula (HFNC) and/or noninvasive mechanical ventilation (NIMV) is controversial. A prospective, cohort, observational, and multicenter study was conducted in 10 ICUs in Spain to analyze the 90-day mortality, tolerance, side effects, and infectious complications of trophic EN in patients requiring HFNC therapy and/or NIVM. A total of 149 patients were enrolled. The mean age, severity scores, tracheobronchitis, bacteremia, and antimicrobial therapy were significantly higher in deceased than in living patients (p < 0.05), and the mortality rate was 14.8%. A total of 110 patients received oral trophic feedings, 36 patients received nasogastric tube feedings (NGFs), and 3 received mixed feedings. Trophic EN was discontinued in only ten (14.9%) patients because of feeding-related complications. The variables selected for the multivariate logistic regression on feeding discontinuation were SOFA upon admission (OR per unit = 1.461) and urea (OR per mg/dL = 1.029). There were no significant differences in the development of new infections according to the route of EN administration. Early trophic feeding administered to patients with acute respiratory failure requiring noninvasive ventilation is safe and feasible, and is associated with few dietary and infectious complications in a mortality, setting comparable to similar studies.
Collapse
Affiliation(s)
- Olivia Reta-Pérez
- Department of Intensive Care, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria (ULPGC), Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain; (O.R.-P.); (M.S.-D.); (M.S.M.-B.)
| | - Manuel Colmenero-Ruiz
- Department of Intensive Care, Hospital Universitario San Cecilio, A. del Conocimiento s/n, 18016 Granada, Spain;
| | - Carmen Rosa Hernández-Socorro
- Department of Radiology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria (ULPGC), Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain;
| | - Pedro Saavedra
- Department of Mathematics, Universidad de Las Palmas de Gran Canaria (ULPGC), 35010 Las Palmas de Gran Canaria, Spain;
| | - Silmary F. Maichle
- Department of Intensive Care, Hospital Clínico Universitario San Carlos, Calle del Prof. Martín Lagos s/n, 28040 Madrid, Spain;
| | - Esther Portugal
- Department of Intensive Care, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal 3, 47003 Valladolid, Spain;
| | - Mariola Cerezo-Arias
- Department of Intensive Care, Hospital Universitario de Badajoz, Av.de Elvas s/n, 06080 Badajoz, Spain;
| | - Laura Sánchez Alés
- Department of Intensive Care, Hospital Universitari de Terrassa: CST, Carr. De Torrebonica s/n, 08227 Terrassa, Spain;
| | - Juan F. Martínez-Carmona
- Department of Intensive Care, Hospital Regional Universitario de Málaga, Av. De Carlos Haya 84, 29010 Málaga, Spain;
| | - Lidon Mateu-Campos
- Department of Intensive Care, Hospital General Universitario de Castellón, Avinguda de Benicàssim 128, 12004 Castelló de la Plana, Spain;
| | - Carol Lorencio-Cárdenas
- Department of Intensive Care, Hospital Universitari Dr Josep Trueta, Avinguda de França, s/n, 17007 Girona, Spain;
| | - Ana García-Miguélez
- Department of Intensive Care, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla s/n, 39008 Santander, Spain;
| | - María Sosa-Durr
- Department of Intensive Care, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria (ULPGC), Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain; (O.R.-P.); (M.S.-D.); (M.S.M.-B.)
| | - María San Martín-Bragado
- Department of Intensive Care, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria (ULPGC), Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain; (O.R.-P.); (M.S.-D.); (M.S.M.-B.)
| | - Sergio Ruiz-Santana
- Department of Intensive Care, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria (ULPGC), Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain; (O.R.-P.); (M.S.-D.); (M.S.M.-B.)
| |
Collapse
|
5
|
Hoosain R, Pillay B, Abdoola S, Graham MA, Krüger E. Swallowing and feeding of young children on high-flow oxygen therapy. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2024; 71:e1-e7. [PMID: 38572899 PMCID: PMC11019085 DOI: 10.4102/sajcd.v71i1.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Oral feeding practices of young patients on high-flow oxygen (HFO2) have been controversial. Limited literature exists on this topic, but new studies suggest introducing oral feeds. OBJECTIVE This study aims to describe the changes in swallowing and feeding of a group of young children on HFO2. METHOD Twelve participants (mean age 34.17 months [s.d. = 3.97]) on HFO2 were assessed clinically at the bedside using the Schedule of Oral Motor Assessment. Assessments were conducted twice to determine the change in characteristics: upon approval from the managing doctor when respiratory stability on HFO2 was achieved and for a second time on the last day of receiving HFO2 (mean 2.6 days apart). Patients received standard in-patient care and speech therapy intervention. RESULTS Most participants displayed typical oral motor function at initial and final assessments for liquid, puree and semi-solid consistencies. Purees and soft solid consistencies were introduced to most participants (n = 11, 91.7%). Solids and chewables were challenging for all participants during both assessments. Half of the participants displayed gagging and a wet vocal quality with thin liquids at the initial assessment only. CONCLUSION This small-scale study found that HFO2 should not preclude oral diets, but in this sample, small amounts of oral feeding could be introduced with caution, in an individualised manner, and with a collaborative multidisciplinary approach. Further research is essential.Contribution: Partial oral feeding of specific consistencies was possible during the assessment of young paediatric in-patients on HFO2. Monitoring of individual patient characteristics and risk factors by a specialist feeding team is essential.
Collapse
Affiliation(s)
- Ruhee Hoosain
- Department of Speech-Language, Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria.
| | | | | | | | | |
Collapse
|
6
|
Pigmans RRWP, Klein-Blommert R, van Gestel MC, Markhorst DG, Hammond P, Boomsma P, Daams T, de Jong JMA, Heeman PM, van Woensel JBM, Dijkman CD, Bem RA. Development of personalized non-invasive ventilation masks for critically ill children: a bench study. Intensive Care Med Exp 2024; 12:21. [PMID: 38424411 PMCID: PMC10904697 DOI: 10.1186/s40635-024-00607-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/22/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Obtaining a properly fitting non-invasive ventilation (NIV) mask to treat acute respiratory failure is a major challenge, especially in young children and patients with craniofacial abnormalities. Personalization of NIV masks holds promise to improve pediatric NIV efficiency. As current customization methods are relatively time consuming, this study aimed to test the air leak and surface pressure performance of personalized oronasal face masks using 3D printed soft materials. Personalized masks of three different biocompatible materials (silicone and photopolymer resin) were developed and tested on three head models of young children with abnormal facial features during preclinical bench simulation of pediatric NIV. Air leak percentages and facial surface pressures were measured and compared for each mask. RESULTS Personalized NIV masks could be successfully produced in under 12 h in a semi-automated 3D production process. During NIV simulation, overall air leak performance and applied surface pressures were acceptable, with leak percentages under 30% and average surface pressure values mostly remaining under normal capillary pressure. There was a small advantage of the masks produced with soft photopolymer resin material. CONCLUSION This first, proof-of-concept bench study simulating NIV in children with abnormal facial features, showed that it is possible to obtain biocompatible, personalized oronasal masks with acceptable air leak and facial surface pressure performance using a relatively short, and semi-automated production process. Further research into the clinical value and possibilities for application of personalized NIV masks in critically ill children is needed.
Collapse
Affiliation(s)
- Rosemijne R W P Pigmans
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
| | - Rozalinde Klein-Blommert
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Monica C van Gestel
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Dick G Markhorst
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Peter Hammond
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Big Data Institute, Old Road Campus, University of Oxford, Oxford, UK
| | - Pim Boomsma
- Department for Medical Innovation and Development, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Tim Daams
- Department for Medical Innovation and Development, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Julia M A de Jong
- Department for Medical Innovation and Development, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Paul M Heeman
- Department for Medical Innovation and Development, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Job B M van Woensel
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Coen D Dijkman
- Department for Medical Innovation and Development, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Reinout A Bem
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Danziato-Neto MA, Barbosa CL, Melo ANMV, Câmara CRS, Carioca AAF, Silva CAB, Alencar ES. Obesity decreases energy and protein intake in hospitalized COVID-19 patients undergoing continuous positive airway pressure treatment. Nutr Res 2023; 118:52-62. [PMID: 37597450 DOI: 10.1016/j.nutres.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/21/2023]
Abstract
Patients with SARS-CoV generally require noninvasive treatments including continuous positive airway pressure (CPAP), and appropriate nutritional therapy. Our hypothesis was that a higher body mass index (BMI) would result in greater respiratory difficulties during CPAP treatment and lead to a reduction in energy and protein intake. The study was conducted prospectively and retrospectively in a Brazilian public hospital. The sample comprised all patients (n = 70) hospitalized in COVID-19 wards and using the Elmo System (ELMO) helmet. To ensure proper nutritional support, the hospital established a standard ELMO diet and questionnaire for estimating dietary adherence. The median length of stay was 11 days (interquartile range, 9-20), and 84.3% of the patients received hospital discharge. The median duration of helmet use was 1.5 days (interquartile range, 1-4). From mid-upper arm circumference adequacy measurements, 35 patients (50%) were classified as being overweight or living with obesity and 36 adult patients (66.7%) were considered living with obesity based on their BMI. The prevalence of overweight elderly patients was 81.3%. The median energy and protein intake adequacy percentages were 65% and 72.5%, respectively. Patients with higher BMIs exhibited lower oxygen flows while wearing the ELMO helmet. Younger age and lower energy and protein intake characterized the obesity group. A correlation between oxygen therapy and food intake in COVID-19 patients undergoing CPAP treatment was observed. Patients with higher BMIs and/or mid-upper arm circumference adequacies were more susceptible to energy and protein intake declines, and patients with obesity presented the lowest intake values.
Collapse
Affiliation(s)
- Milton A Danziato-Neto
- Department of Health Science, Ribeirão Preto School of Medicine, University of São Paulo, 14049-900, Ribeirão Preto, São Paulo, Brazil.
| | - Cecília L Barbosa
- Residency in Cardiopulmonary Care, Integrated Residency in Health, School of Public Health, 60165-090, Fortaleza, Ceará, Brazil
| | - Angela N M V Melo
- Residency in Cardiopulmonary Care, Integrated Residency in Health, School of Public Health, 60165-090, Fortaleza, Ceará, Brazil
| | - Cristiane R S Câmara
- Health Sciences Center, University of Fortaleza, 60811-905, Fortaleza, Ceará, Brazil
| | - Antônio A F Carioca
- Health Sciences Center, University of Fortaleza, 60811-905, Fortaleza, Ceará, Brazil
| | - Carlos A B Silva
- Health Sciences Center, University of Fortaleza, 60811-905, Fortaleza, Ceará, Brazil
| | - Eudóxia S Alencar
- Residency in Cardiopulmonary Care, Integrated Residency in Health, School of Public Health, 60165-090, Fortaleza, Ceará, Brazil; Health Sciences Center, University of Fortaleza, 60811-905, Fortaleza, Ceará, Brazil
| |
Collapse
|
8
|
Sierra-Colomina M, Yehia NA, Mahmood F, Parshuram C, Mtaweh H. A Retrospective Study of Complications of Enteral Feeding in Critically Ill Children on Noninvasive Ventilation. Nutrients 2023; 15:2817. [PMID: 37375722 DOI: 10.3390/nu15122817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
The utilization of noninvasive ventilation (NIV) in pediatric intensive care units (PICUs), to support children with respiratory failure and avoid endotracheal intubation, has increased. Current guidelines recommend initiating enteral nutrition (EN) within the first 24-48 h post admission. This practice remains variable among PICUs due to perceptions of a lack of safety data and the potential increase in respiratory and gastric complications. The objective of this retrospective study was to evaluate the association between EN and development of extraintestinal complications in children 0-18 years of age on NIV for acute respiratory failure. Of 332 patients supported with NIV, 249 (75%) were enterally fed within the first 48 h of admission. Respiratory complications occurred in 132 (40%) of the total cohort and predominantly in non-enterally fed patients (60/83, 72% vs. 72/249, 29%; p < 0.01), and they occurred earlier during ICU admission (0 vs. 2 days; p < 0.01). The majority of complications were changes in the fraction of inspired oxygen (220/290, 76%). In the multivariate evaluation, children on bilevel positive airway pressure (BiPAP) (23/132, 17% vs. 96/200, 48%; odds ratio [OR] = 5.3; p < 0.01), receiving a higher fraction of inspired oxygen (FiO2) (0.42 vs. 0.35; OR = 6; p = 0.03), and with lower oxygen saturation (SpO2) (91% vs. 97%; OR = 0.8; p < 0.01) were more likely to develop a complication. Time to discharge from the intensive care unit (ICU) was longer for patients with complications (11 vs. 3 days; OR = 1.12; p < 0.01). The large majority of patients requiring NIV can be enterally fed without an increase in respiratory complications after an initial period of ICU stabilization.
Collapse
Affiliation(s)
| | - Nagam Anna Yehia
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Farhan Mahmood
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Christopher Parshuram
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Haifa Mtaweh
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| |
Collapse
|
9
|
Bechtold ML, Brown PM, Escuro A, Grenda B, Johnston T, Kozeniecki M, Limketkai BN, Nelson KK, Powers J, Ronan A, Schober N, Strang BJ, Swartz C, Turner J, Tweel L, Walker R, Epp L, Malone A. When is enteral nutrition indicated? JPEN J Parenter Enteral Nutr 2022; 46:1470-1496. [PMID: 35838308 DOI: 10.1002/jpen.2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/07/2022]
Abstract
Enteral nutrition (EN) is a vital component of nutrition around the world. EN allows for delivery of nutrients to those who cannot maintain adequate nutrition by oral intake alone. Common questions regarding EN are when to initiate and in what scenarios it is safe. The answers to these questions are often complex and require an evidence-based approach. The Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) established an Enteral Nutrition Committtee to address the important questions surrounding the indications for EN. Consensus recommendations were established based on eight extremely clinically relevant questions regarding EN indications as deemed by the Enteral Nutrition Committee. These consensus recommendations may act as a guide for clinicians and stakeholders on difficult questions pertaining to indications for EN. This paper was approved by the ASPEN Board of Directors.
Collapse
Affiliation(s)
| | | | | | - Brandee Grenda
- Morrison Healthcare at Atrium Health Navicant, Charlotte, North Carolina, USA
| | - Theresa Johnston
- Nutrition Support Team, Christiana Care Health System, Newark, Delaware, USA
| | | | | | | | - Jan Powers
- Nursing Research and Professional Practice, Parkview Health System, Fort Wayne, Indiana, USA
| | - Andrea Ronan
- Fanconi Anemia Research Fund, Eugene, Oregon, USA
| | - Nathan Schober
- Cancer Treatment Centers of America - Atlanta, Newnan, Georgia, USA
| | | | - Cristina Swartz
- Northwestern Medicine Delnor Cancer Center, Chicago, Illinois, USA
| | - Justine Turner
- Department of Pediatrics, Division of Gastroenterology and Nutrition, University of Alberta, Edmonton, Canada
| | | | - Renee Walker
- Michael E. DeBakey Veteran Affairs Medical Center, Houston, Texas, USA
| | - Lisa Epp
- Mayo Clinic, Rochester, Minnesota, USA
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | | |
Collapse
|
10
|
Hussain Khan Z, Maki Aldulaimi A, Varpaei HA, Mohammadi M. Various Aspects of Non-Invasive Ventilation in COVID-19 Patients: A Narrative Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:194-209. [PMID: 35634520 PMCID: PMC9126903 DOI: 10.30476/ijms.2021.91753.2291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/21/2021] [Accepted: 10/01/2021] [Indexed: 01/08/2023]
Abstract
Non-invasive ventilation (NIV) is primarily used to treat acute respiratory failure. However, it has broad applications to manage a range of other diseases successfully. The main advantage of NIV lies in its capability to provide the same physiological effects as invasive ventilation while avoiding the placement of an artificial airway and its associated life-threatening complications. The war on the COVID-19 pandemic is far from over. The present narrative review aimed at identifying various aspects of NIV usage, in COVID-19 and other patients, such as the onset time, mode, setting, positioning, sedation, and types of interface. A search for articles published from May 2020 to April 2021 was conducted using MEDLINE, PMC central, Scopus, Web of Science, Cochrane Library, and Embase databases. Of the initially identified 5,450 articles, 73 studies and 24 guidelines on the use of NIV were included. The search was limited to studies involving human cases and English language articles. Despite several reported benefits of NIV, the evidence on the use of NIV in COVID-19 patients does not yet fully support its routine use.
Collapse
Affiliation(s)
- Zahid Hussain Khan
- Department of Anesthesiology and Critical Care, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmed Maki Aldulaimi
- Al-furat Al-awsat Hospital, Al-furat Al-awsat Technical University, Health and Medical Technical College, Department of Anesthesia and Critical Care, Kufa, Iraq
| | - Hesam Aldin Varpaei
- Department of Nursing and Midwifery, School of Nursing, Islamic Azad University Tehran Medical Sciences, Tehran, Iran
| | - Mostafa Mohammadi
- Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran. Iran
| |
Collapse
|
11
|
Cifer M, Strnad M, Fekonja Z. Seznanjenost osebja zdravstvene nege z neinvazivno mehansko ventilacijo. OBZORNIK ZDRAVSTVENE NEGE 2022. [DOI: 10.14528/snr.2022.56.1.3088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: Uspešno zdravljenje z neinvazivno mehansko ventilacijo predstavlja velik izziv, saj jo je mogoče učinkovito upravljati v primeru zadostne usposobljenosti vseh članov tima. Namen raziskave je bil oceniti znanje zdravstvenih delavcev, ki se srečujejo s tovrstnim zdravljenjem.Metode: Izvedena je bila kvantitativna presečna opazovalna raziskava. Vanjo je bilo vključenih 68 medicinskih sester, zaposlenih v intenzivnih enotah in na urgenci dveh bolnišnic v severovzhodni Sloveniji. Podatki so bili zbrani s pomočjo vprašalnika ter statistično analizirani in obdelani z uporabo opisne in sklepne statistike.Rezultati: V raziskavi ugotavljamo, da 76,5 % anketirancev meni, da je njihovo znanje o neinvazivni mehanski ventilaciji precej dobro. Znanje o neinvazivni mehanski ventilaciji je 85,3 % anketirancev pridobilo od sodelavcev v službi in 60,3 % od zdravnikov na oddelku. Povprečna vrednost doseženih točk, pridobljena pri vprašanjih o znanju glede uporabe neinvazivne mehanske ventilacije, je bila 23,13 (s = 4.35) od možnih 33. Med delavci, zaposlenimi v urgentnem centru in na oddelkih intenzivne enote, ne obstajajo statistično pomembne razlike v znanju o neinvazivni mehanski ventilaciji (p = 0,456).Diskusija in zaključek: Ugotovili smo, da bi anketiranci potrebovali dodatna usposabljanja s področja neinvazivne mehanske ventilacije. Smiselno bi bilo, da se na državni ravni oziroma ravni posameznih bolnišnic organizirajo izobraževanja s tega področja, na katera se povabi vse zaposlene, ki se srečujejo z neinvazivno mehansko ventilacijo.
Collapse
|
12
|
Hinkelmann JV, de Oliveira NA, Marcato DF, Costa ARRO, Ferreira AM, Tomaz M, Rodrigues TJ, Mendes AP. Nutritional Support Protocol for patients with COVID-19. Clin Nutr ESPEN 2022; 49:544-550. [PMID: 35623865 PMCID: PMC8915452 DOI: 10.1016/j.clnesp.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 11/28/2022]
Abstract
Background & aims COVID-19 is a hypercatabolic disease with possible pulmonary and gastrointestinal symptoms, and consequent deterioration of the nutritional status and the worst clinical prognosis. This study presents a protocol to guide the nutritional care of adult and elderly people non-critically and critically ill with COVID-19. Methods A critical review of the literature was carried out in the databases PubMed, Scielo, Bireme, and Science Direct, in search of articles and guidelines that presented assessment criteria and nutritional conduct for COVID-19 and Severe Acute Respiratory Syndrome (SARS), as well as guidelines for managing the symptoms presented by patients. Results The results are recommendations based on the literature and the professional experience of nutritionists who provide nutritional assistance to individuals hospitalized with COVID-19 since the beginning of the pandemic in Brazil. We present tools and suggestions for assessing the nutritional status, calculating nutritional needs, initiating nutritional therapy and monitoring tolerance to it, nutritional monitoring during hospitalization, and guidelines for hospital discharge. Conclusion Patients with COVID-19 are at nutritional risk. A complete nutritional assessment (anthropometric, dietary, and laboratory assessment) enables the establishment of an individualized nutritional approach in order to contribute to better clinical and nutritional prognoses.
Collapse
Affiliation(s)
| | | | | | | | | | - Marcilene Tomaz
- Santa Casa de Misericórdia de Juiz de Fora, Minas Gerais, Brazil
| | | | | |
Collapse
|
13
|
Crimi C, Pierucci P, Renda T, Pisani L, Carlucci A. High-Flow Nasal Cannula and COVID-19: A Clinical Review. Respir Care 2022; 67:227-240. [PMID: 34521762 PMCID: PMC9993935 DOI: 10.4187/respcare.09056] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, noninvasive respiratory support has played a central role in managing patients affected by moderate-to-severe acute hypoxemic respiratory failure, despite inadequate scientific evidence to support its usage. High-flow nasal cannula (HFNC) treatment has gained popularity because of its effectiveness in delivering a high fraction of humidified oxygen, which improves ventilatory efficiency and the respiratory pattern, as well as its reported high tolerability, ease of use, and application outside of ICUs. Nevertheless, the risk of infection transmission to health-care workers has raised some concerns about its use in the first wave of the pandemic outbreak, with controversial recommendations provided by different scientific societies. This narrative review provides an overview of the recent evidence on the physiologic rationale, risks, and benefits of using HFNC instead of conventional oxygen therapy and other types of noninvasive respiratory support devices, such as continuous positive airway pressure and noninvasive ventilation in patients affected by COVID-19 pneumonia with associated acute hypoxemic respiratory failure. It also summarizes the available evidence with regard to the clinical use of HFNC during the current pandemic and its reported outcomes, and highlights the risks of bioaerosol dispersion associated with HFNC use.
Collapse
Affiliation(s)
- Claudia Crimi
- Respiratory Medicine Unit, "Policlinico-Vittorio Emanuele-San Marco," University Hospital, Catania, Italy.
| | - Paola Pierucci
- Respiratory Medicine Unit, Policlinico "Aldo Moro" University Hospital, Bari, Italy
| | - Teresa Renda
- Respiratory and Critical Care Unit, Cardio-thoracic and Vascular Department, Careggi Teaching Hospital, Florence, Italy
| | - Lara Pisani
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine, Alma Mater Studiorum University, Bologna, Italy
| | - Annalisa Carlucci
- Department of Medicine and Surgery, Università Insubria, Varese-Como, Italy
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| |
Collapse
|
14
|
Wehlmann H, Ochmann T. [Influence of nurses on the experience of noninvasive ventilation]. Med Klin Intensivmed Notfmed 2021; 116:702-707. [PMID: 34191044 DOI: 10.1007/s00063-021-00836-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022]
Abstract
Noninvasive ventilation (NIV) is established as an integral part of intensive care therapy for respiratory insufficiency. However, it is associated with restrictions on patient autonomy and comfort. A successful course of therapy is largely dependent on the acceptance and adherence of the patients concerned. Intensive care nurses can have a significant influence on the success of the therapy by dealing with the subjective experience of the patients and by maintaining close contact with them. The prerequisite for this is profound knowledge of the different technical aspects of therapy and equipment as well as positive and negative factors influencing NIV tolerance in order to be able to offer and implement an individual intervention.
Collapse
Affiliation(s)
- Henning Wehlmann
- Interdisziplinäre Intensivstation, Klinik für Anästhesie und Intensivmedizin, Alexianer St. Hedwig Kliniken Berlin, Große Hamburger Straße 5-11, 10115, Berlin, Deutschland.
| | - Tobias Ochmann
- Medizinische Intensivstation, Klinik für Kardiologie, Internistische Intensivmedizin und Angiologie, Zentrum für Innere Medizin, Kath. Marienkrankenhaus Hamburg, Hamburg, Deutschland
| |
Collapse
|
15
|
Komeswaran K, Khanal A, Powell K, Caprirolo G, Majcina R, Robbs RS, Basnet S. Enteral Feeding for Children on Bilevel Positive Pressure Ventilation for Status Asthmaticus. J Pediatr Intensive Care 2021; 12:31-36. [PMID: 36742255 PMCID: PMC9894693 DOI: 10.1055/s-0041-1730901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/25/2021] [Indexed: 02/07/2023] Open
Abstract
A retrospective data analysis was conducted to evaluate enteral nutrition practices for children admitted with status asthmaticus in a single-center pediatric intensive care unit. Of 406 charts, 315 were analyzed (63% male); 135 on bilevel positive airway pressure ventilation (BIPAP) and 180 on simple mask. Overall median age and weight were 6.0 (interquartile range [IQR]: 6.0) years and 24.8 (IQR: 20.8) kg, respectively. All children studied were on full feeds while still on BIPAP and simple mask; 99.3 and 100% were fed per oral, respectively. Median time to initiation of feeds and full feeds was longer in the BIPAP group, 11.0 (IQR: 20) and 23.0 hours (IQR: 26), versus simple mask group, 4.3 (IQR: 7) and 12.0 hours (IQR: 15), p = 0.001. The results remained similar after adjusting for gender, weight, clinical asthma score at admission, use of adjunct therapy, and duration of continuous albuterol. By 24 hours, 81.5% of patients on BIPAP and 96.6% on simple mask were started on feeds. Compared with simple mask, patients on BIPAP were sicker with median asthma score at admission of 4 (IQR: 2) versus 3 (IQR: 2) on simple mask, requiring more adjunct therapy (80.0 vs. 43.9%), and a longer median length of therapy of 41.0 (IQR: 41) versus 20.0 hours (IQR: 29), respectively, p = 0.001. There were no complications such as aspiration pneumonia, and none required invasive mechanical ventilation in either group. Enteral nutrition was effectively and safely initiated and continued for children admitted with status asthmaticus, including those on noninvasive bilevel ventilation therapy.
Collapse
Affiliation(s)
- Kavipriya Komeswaran
- Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, Illinois, United Sates
| | - Aayush Khanal
- Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, Illinois, United Sates
| | - Kimberly Powell
- Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, Illinois, United Sates
| | - Giovanna Caprirolo
- Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, Illinois, United Sates
| | - Ryan Majcina
- Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, Illinois, United Sates
| | - Randall S. Robbs
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois, United Sates
| | - Sangita Basnet
- Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, Illinois, United Sates,Address for correspondence Sangita Basnet, MD, FAAP, FCCM Department of Pediatrics, Division of Critical care, Southern Illinois University School of Medicine, St John's Children's Hospital415 N. 9th Street, Suite 4W64, PO Box 19676, Springfield, IL 62794United Sates
| |
Collapse
|
16
|
Song F, Ma H, Wang S, Qin T, Xu Q, Yuan H, Li F, Wang Z, Liao Y, Tan X, Song X, Zhang Q, Huang D. Nutritional screening based on objective indices at admission predicts in-hospital mortality in patients with COVID-19. Nutr J 2021; 20:46. [PMID: 34034769 PMCID: PMC8145188 DOI: 10.1186/s12937-021-00702-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/28/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Could nutritional status serve as prognostic factors for coronavirus disease 2019 (COVID-19)? The present study evaluated the clinical and nutritional characteristics of COVID-19 patients and explored the relationship between risk for malnutrition at admission and in-hospital mortality. METHODS A retrospective, observational study was conducted in two hospitals in Hubei, China. Confirmed cases of COVID-19 were typed as mild/moderate, severe, or critically ill. Clinical data and in-hospital death were collected. The risk for malnutrition was assessed using the geriatric nutritional risk index (GNRI), the prognostic nutritional index (PNI), and the Controlling Nutritional Status (CONUT) via objective parameters at admission. RESULTS Two hundred ninety-five patients were enrolled, including 66 severe patients and 41 critically ill patients. Twenty-five deaths were observed, making 8.47% in the whole population and 37.88% in the critically ill subgroup. Patients had significant differences in nutrition-related parameters and inflammatory biomarkers among three types of disease severity. Patients with lower GNRI and PNI, as well as higher CONUT scores, had a higher risk of in-hospital mortality. The receiver operating characteristic curves demonstrated the good prognostic implication of GNRI and CONUT score. The multivariate logistic regression showed that baseline nutritional status, assessed by GNRI, PNI, or CONUT score, was a prognostic indicator for in-hospital mortality. CONCLUSIONS Despite variant screening tools, poor nutritional status was associated with in-hospital death in patients infected with COVID-19. This study highlighted the importance of nutritional screening at admission and the new insight of nutritional monitoring or therapy.
Collapse
Affiliation(s)
- Feier Song
- Department of Emergency and Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080 China
| | - Huan Ma
- Department of Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Cardiovascular Institute, Guangzhou, 510080 China
| | - Shouhong Wang
- Department of Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080 China
| | - Tiehe Qin
- Department of Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080 China
| | - Qing Xu
- Department of Emergency Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233 China
| | - Huiqing Yuan
- Department of Respiratory and Critical Care Medicine, the First People’s Hospital of Shaoguan, Shaoguan, 512000 China
| | - Fei Li
- Department of Emergency, the First Affiliated Hospital of Jingzhou, Jingzhou, 434000 China
| | - Zhonghua Wang
- Department of Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080 China
| | - Youwan Liao
- Department of Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080 China
| | - Xiaoping Tan
- Department of Gastroenterology, the First Affiliated Hospital of Yangtze University, Jingzhou, 434000 China
| | - Xiuchan Song
- Department of Critical Care Medicine, Dongguan Eighth People’s Hospital, Dongguan Children’s Hospital, Dongguan, 523000 China
| | - Qing Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Yangtze University, Jingzhou, 434000 China
| | - Daozheng Huang
- Department of Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080 China
| |
Collapse
|
17
|
A Retrospective Analysis of Feeding Practices and Complications in Patients with Critical Bronchiolitis on Non-Invasive Respiratory Support. CHILDREN-BASEL 2021; 8:children8050410. [PMID: 34069996 PMCID: PMC8157845 DOI: 10.3390/children8050410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 11/16/2022]
Abstract
Limited data exist regarding feeding pediatric patients managed on non-invasive respiratory support (NRS) modes that augment oxygenation and ventilation in the setting of acute respiratory failure. We conducted a retrospective cohort study to explore the safety of feeding patients managed on NRS with acute respiratory failure secondary to bronchiolitis. Children up to two years old with critical bronchiolitis managed on continuous positive airway pressure, bilevel positive airway pressure, or RAM cannula were included. Of the 178 eligible patients, 64 were reportedly nil per os (NPO), while 114 received enteral nutrition (EN). Overall equivalent in severity of illness, younger patients populated the EN group, while the NPO group experienced a higher incidence of intubation. Duration of stay in the pediatric intensive care unit and non-invasive respiratory support were shorter in the NPO group, though intubation eliminated the former difference. Within the EN group, ninety percent had feeds initiated within 48 h and 94% reached full feeds within 7 days of NRS initiation, with an 8% complication and <1% aspiration rate. Reported complications did not result in escalation of respiratory support. Notably, a significant improvement in heart rate and respiratory rate was noted after feeds initiation. Taken together, our study supports the practice of early enteral nutrition in patients with critical bronchiolitis requiring NRS.
Collapse
|
18
|
Energy and protein intake in critically ill people with respiratory failure treated by high-flow nasal-cannula oxygenation: An observational study. Nutrition 2020; 84:111117. [PMID: 33486298 DOI: 10.1016/j.nut.2020.111117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES High-flow nasal-cannula (HFNC) oxygen therapy is increasingly used in the management of respiratory distress. Since this treatment may be required for many days and may impair nutritional intake, this study planned to observe the energy and protein intake of individuals receiving this therapy. METHODS Forty consecutive patients requiring HFNC oxygenation after extubation or to prevent intubation from November 2017 to June 2018 were included in the study. Demographics, route of nutrition (oral, enteral, or parenteral), calories and protein prescribed and administered, and complications were noted until discharge. Statistical analysis used χ2 or Kruskal-Wallis H test. RESULTS HFNC oxygen therapy was applied for 42 d in the 40 participants. Overall, individuals with HFNC oxygenation therapy received 449.5 (interquartile range [IQR], 312-850) kcal/d and 19.25 (IQR, 13.9-33.3) g/d protein. Twenty-one participants treated with enteral nutrition received 387 (IQR, 273-931) kcal/d and 18.5 (IQR, 13.9-33.3) g/d protein, whereas those with oral feeding (n = 13) received higher totals of calories, 600 (IQR, 459-850) kcal/d (P = 0.056), and protein, 22 (IQR, 20-45) g/d (P = 0.005). Four participants received parenteral nutrition alone, providing 543 (IQR, 375-886.5) kcal/d and 8.7 (IQR, 0-20) g/d protein. When parenteral nutrition was administered with enteral nutrition, it provided only 324 (IQR, 290-358) kcal/d. Two participants did not receive any nutritional support. The overall length of stay in the intensive care unit was 8 (IQR, 5-17.5) d. Participants receiving enteral nutrition had a longer stay (14 d; IQR, 8-20) than the oral-diet group (4 d; IQR, 2-10; P < 0.03). The rate of intubation after HFNC therapy was not significantly different between the groups (P = 0.586). CONCLUSIONS Administration of HFNC oxygen therapy was associated with significant underfeeding. In order to reach optimal caloric and protein intake, parenteral nutrition may be considered.
Collapse
|
19
|
Kagan I, Hellerman-Itzhaki M, Neuman I, Glass YD, Singer P. Reflux events detected by multichannel bioimpedance smart feeding tube during high flow nasal cannula oxygen therapy and enteral feeding: First case report. J Crit Care 2020; 60:226-229. [PMID: 32882605 PMCID: PMC7442574 DOI: 10.1016/j.jcrc.2020.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/09/2020] [Accepted: 08/03/2020] [Indexed: 01/06/2023]
Abstract
The use of high flow nasal cannula (HFNC) oxygen therapy is common in patients with respiratory distress to prevent intubation or ensure successful extubation. However, these critical patients also need medical nutritional support and practitioners are often reluctant to prescribe oral or enteral feeding, leading to a decrease in energy and protein intake. Vomiting and aspiration are the major concerns. A new technology detecting the presence and duration of gastro-esophageal reflux and preventing aspiration in real-time has been developed and our case shows how HFNC oxygen therapy exposes patients to significantly more reflux events as compared to mechanical ventilation. This is the first description of this technique observed in critical care.
Collapse
Affiliation(s)
- Ilya Kagan
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Israel.
| | - Moran Hellerman-Itzhaki
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Israel
| | - Ido Neuman
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Israel
| | - Yehuda D Glass
- Medical Intensive Care Unit, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Israel
| |
Collapse
|
20
|
Vergara J, Skoretz SA, Brodsky MB, Miles A, Langmore SE, Wallace S, Seedat J, Starmer HM, Bolton L, Clavé P, Freitas SV, Bogaardt H, Matsuo K, de Souza CM, Mourão LF. Assessment, Diagnosis, and Treatment of Dysphagia in Patients Infected With SARS-CoV-2: A Review of the Literature and International Guidelines. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:2242-2253. [PMID: 32960646 DOI: 10.1044/2020_ajslp-20-00163] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Speech-language pathologists are playing a crucial role in the assessment and management of patients infected with severe acute respiratory syndrome coronavirus 2. Our goal was to synthesize peer-reviewed literature and association guidelines from around the world regarding dysphagia assessment and management for this specific population. Method A review of publications available in the PubMed database and official guidelines of international groups was performed on May 23, 2020. The information was synthesized and categorized into three content areas for swallowing: clinical evaluation, instrumental assessment, and rehabilitation. Results Five publications were identified in the PubMed database. Following title, abstract, and full-text review, only three publications met inclusion criteria: two reviews and one narrative report. Additionally, 19 international guidelines were reviewed. To assess swallowing, a modified clinical evaluation was recommended and only following a risk assessment. Instrumental assessments were often considered aerosol generating, especially transnasal procedures such as endoscopy and manometry. For this reason, many associations recommended that these examinations be performed only when essential and with appropriate personal protective equipment. Guidelines recommended that intervention should focus on compensatory strategies, including bolus modification, maneuvers/postural changes, and therapeutic exercises that can be conducted with physical distancing. Respiratory training devices were not recommended during rehabilitation. Conclusions International associations have provided extensive guidance regarding the level of risk related to the management of dysphagia in this population. To date, there are no scientific papers offering disease and/or recovery profiling for patients with dysphagia and coronavirus disease 2019. As a result, research in this area is urgently needed.
Collapse
Affiliation(s)
- José Vergara
- Department of Surgery, University of Campinas, Campinas, São Paulo, Brazil
| | - Stacey A Skoretz
- School of Audiology & Speech Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Martin B Brodsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Anna Miles
- Speech Science, University of Auckland, New Zealand
| | - Susan E Langmore
- Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Boston University, MA
| | - Sarah Wallace
- Department of Speech, Voice and Swallowing, Wythenshawe Hospital, Manchester University NHS Foundation Trust, United Kingdom
- National Tracheostomy Safety Project, Manchester, United Kingdom
| | - Jaishika Seedat
- Department of Speech and Hearing Therapy, University of Witwatersrand, Johannesburg, South Africa
| | - Heather M Starmer
- Division of Head and Neck Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University, Palo Alto, CA
| | - Lee Bolton
- Speech and Language Therapy Service, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (Ciberehd), Hospital de Mataró, Autonomous University of Barcelona, Spain
| | - Susana Vaz Freitas
- Faculty of Health Sciences, Speech Therapy Department, University Fernando Pessoa, Porto, Portugal
- Centro Hospitalar Universitário do Porto, ENT Department, Portugal
- Laboratório de Inteligência Artificial e Análise de Dados, LIAAD-INESCTEC, Porto, Portugal
| | - Hans Bogaardt
- Faculty of Medicine and Health, The University of Sydney, New South Wales Australia
| | - Koichiro Matsuo
- Department of Dentistry and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | | | | |
Collapse
|
21
|
Malnutrition and nutritional therapy in patients with SARS-CoV-2 disease. Clin Nutr 2020; 40:1330-1337. [PMID: 32900518 PMCID: PMC7450234 DOI: 10.1016/j.clnu.2020.08.021] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/31/2020] [Accepted: 08/15/2020] [Indexed: 01/01/2023]
Abstract
Rationale The prevalence of malnutrition and the provided nutritional therapy were evaluated in all the patients with SARS-CoV-2 infection (COVID-19) hospitalized in a 3rd level hospital in Italy. Methods A one-day audit was carried out recording: age, measured or estimated body weight (BW) and height, body mass index (BMI, kg/m2), 30-day weight loss (WL), comorbidities, serum albumin and C-reactive protein (CRP: nv < 0.5 mg/dL), hospital diet (HD) intake, oral nutritional supplements (ONS), enteral (EN) and parenteral nutrition (PN). Modified NRS-2002 tool and GLIM criteria were used for nutritional risk screening and for the diagnosis of malnutrition, respectively. Results A total of 268 patients was evaluated; intermediate care units (IMCUs, 61%), sub-intensive care units (SICUs, 8%), intensive care units (ICUs, 17%) and rehabilitation units (RUs, 14%): BMI: <18.5, 9% (higher in RUs, p = 0.008) and ≥30, 13% (higher in ICUs, p = 0.012); WL ≥ 5%, 52% (higher in ICUs and RUs, p = 0.001); CRP >0.5: 78% (higher in ICUs and lower in RUs, p < 0.001); Nutritional risk and malnutrition were present in 77% (higher in ICUs and RUs, p < 0.001) and 50% (higher in ICUs, p = 0.0792) of the patients, respectively. HD intake ≤50%, 39% (higher in IMCUs and ICUs, p < 0.001); ONS, EN and PN were prescribed to 6%, 13% and 5%, respectively. Median energy and protein intake/kg BW were 25 kcal and 1.1 g (both lower in ICUs, p < 0.05) respectively. Conclusions Most of the patients were at nutritional risk, and one-half of them was malnourished. The frequency of nutritional risk, malnutrition, disease/inflammation burden and decrease intake of HD differed among the intensity of care settings, where the patients were managed according to the severity of the disease. The patient energy and protein intake were at the lowest limit or below the recommended amounts, indicating the need for actions to improve the nutritional care practice.
Collapse
|
22
|
Caccialanza R, Laviano A, Lobascio F, Montagna E, Bruno R, Ludovisi S, Corsico AG, Di Sabatino A, Belliato M, Calvi M, Iacona I, Grugnetti G, Bonadeo E, Muzzi A, Cereda E. Early nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): Rationale and feasibility of a shared pragmatic protocol. Nutrition 2020; 74:110835. [PMID: 32280058 PMCID: PMC7194616 DOI: 10.1016/j.nut.2020.110835] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Beginning in December 2019, the 2019 novel coronavirus disease (COVID-19) has caused a pneumonia epidemic that began in Wuhan, China, and is rapidly spreading throughout the whole world. Italy is the hardest hit country after China. Considering the deleterious consequences of malnutrition, which certainly can affect patients with COVID-19, the aim of this article is to present a pragmatic protocol for early nutritional supplementation of non-critically ill patients hospitalized for COVID-19 disease. It is based on the observation that most patients present at admission with severe inflammation and anorexia leading to a drastic reduction of food intake, and that a substantial percentage develops respiratory failure requiring non-invasive ventilation or even continuous positive airway pressure. METHODS High-calorie dense diets in a variety of different consistencies with highly digestible foods and snacks are available for all patients. Oral supplementation of whey proteins as well as intravenous infusion of multivitamin, multimineral trace elements solutions are implemented at admission. In the presence of 25-hydroxyvitamin D deficit, cholecalciferol is promptly supplied. If nutritional risk is detected, two to three bottles of protein-calorie oral nutritional supplements (ONS) are provided. If <2 bottles/d of ONS are consumed for 2 consecutive days and/or respiratory conditions are worsening, supplemental/total parenteral nutrition is prescribed. CONCLUSION We are aware that our straight approach may be debatable. However, to cope with the current emergency crisis, its aim is to promptly and pragmatically implement nutritional care in patients with COVID-19, which might be overlooked despite being potentially beneficial to clinical outcomes and effective in preventing the consequences of malnutrition in this patient population.
Collapse
Affiliation(s)
- Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, La Sapienza University, Rome, Italy
| | - Federica Lobascio
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elisabetta Montagna
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Raffaele Bruno
- Division of Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Pavia, Italy
| | - Serena Ludovisi
- Division of Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Pavia, Italy
| | - Angelo Guido Corsico
- Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Mirko Belliato
- UOS Advanced Respiratory Intensive Care Unit, UOC Anestesia e Rianimazione 1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Monica Calvi
- Pharmacy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Isabella Iacona
- Pharmacy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giuseppina Grugnetti
- Nursing Technical and Rehabilitation Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elisa Bonadeo
- UOC Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alba Muzzi
- UOC Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
23
|
|
24
|
Nutritional management of COVID-19 patients in a rehabilitation unit. Eur J Clin Nutr 2020; 74:860-863. [PMID: 32433599 PMCID: PMC7237874 DOI: 10.1038/s41430-020-0664-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/02/2020] [Accepted: 05/06/2020] [Indexed: 01/13/2023]
|
25
|
Abstract
The coronavirus disease of 2019 (COVID-19) pandemic has placed many healthcare systems, including the NHS, under unprecedented pressure. Mortality appears to be highest among older people and those with comorbidities, who are also often the most at risk of undernutrition in society. Despite international efforts to identify a specific treatment, therapy remains supportive and is principally focused on optimising respiratory function. However, the timely identification and correction of undernutrition also has the potential to improve outcomes cost-effectively, and should not be forgotten. This piece outlines why nutritional status may be particularly compromised during this crisis, among both the population and hospital inpatients. Practical steps to improve nutritional status at a time when hospital services are particularly stretched are also considered. Finally, the case is made for behaviour change at all levels including government, the general population and healthcare professionals.
Collapse
Affiliation(s)
- Shameer Mehta
- University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
26
|
Barazzoni R, Bischoff SC, Breda J, Wickramasinghe K, Krznaric Z, Nitzan D, Pirlich M, Singer P. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Clin Nutr 2020; 39:1631-1638. [PMID: 32305181 PMCID: PMC7138149 DOI: 10.1016/j.clnu.2020.03.022] [Citation(s) in RCA: 472] [Impact Index Per Article: 118.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemics is posing unprecedented challenges and threats to patients and healthcare systems worldwide. Acute respiratory complications that require intensive care unit (ICU) management are a major cause of morbidity and mortality in COVID-19 patients. Patients with worst outcomes and higher mortality are reported to include immunocompromised subjects, namely older adults and polymorbid individuals and malnourished people in general. ICU stay, polymorbidity and older age are all commonly associated with high risk for malnutrition, representing per se a relevant risk factor for higher morbidity and mortality in chronic and acute disease. Also importantly, prolonged ICU stays are reported to be required for COVID-19 patients stabilization, and longer ICU stay may per se directly worsen or cause malnutrition, with severe loss of skeletal muscle mass and function which may lead to disability, poor quality of life and additional morbidity. Prevention, diagnosis and treatment of malnutrition should therefore be routinely included in the management of COVID-19 patients. In the current document, the European Society for Clinical Nutrition and Metabolism (ESPEN) aims at providing concise guidance for nutritional management of COVID-19 patients by proposing 10 practical recommendations. The practical guidance is focused to those in the ICU setting or in the presence of older age and polymorbidity, which are independently associated with malnutrition and its negative impact on patient survival.
Collapse
Affiliation(s)
- Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy.
| | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - Joao Breda
- WHO European Office for Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Kremlin Wickramasinghe
- WHO European Office for Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Zeljko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, University of Zagreb, Croatia
| | - Dorit Nitzan
- Health Emergencies and Operation Management, World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Matthias Pirlich
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology & Clinical Nutrition, Berlin, Germany
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | |
Collapse
|