Enteral Feeding for Children on Bilevel Positive Pressure Ventilation for Status Asthmaticus

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.

Keywords

pediatric - enteral nutrition - bilevel positive pressure ventilation - noninvasive ventilation - asthma - status asthmaticus

Note

This work was performed at St. John’s Children’s Hospital, Southern Illinois University School of Medicine in Springfield, IL.

Publication History

Received: 14 January 2021

Accepted: 25 March 2021

Article published online:
08 June 2021

• References

• 1 American Lung Association. Asthma and children fact sheet. Accessed April 16, 2021 at: https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/learn-about-asthma/asthma-children-facts-sheet
• 2 Basnet S, Mander G, Andoh J, Klaska H, Verhulst S, Koirala J. Safety, efficacy, and tolerability of early initiation of noninvasive positive pressure ventilation in pediatric patients admitted with status asthmaticus: a pilot study. Pediatr Crit Care Med 2012; 13 (04) 393-398
• 3 Korang SK, Feinberg J, Wetterslev J, Jakobsen JC. Non-invasive positive pressure ventilation for acute asthma in children. Cochrane Database Syst Rev 2016; 9: CD012067
• 4 Lim WJ, Mohammed Akram R, Carson KV. et al. Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma. Cochrane Database Syst Rev 2012; 12: CD004360
• 5 Nanchal R, Kumar G, Majumdar T. et al. Utilization of mechanical ventilation for asthma exacerbations: analysis of a national database. Respir Care 2014; 59 (05) 644-653
• 6 Stefan MS, Nathanson BH, Lagu T. et al. Outcomes of noninvasive and invasive ventilation in patients hospitalized with asthma exacerbation. Ann Am Thorac Soc 2016; 13 (07) 1096-1104
• 7 Leroue MK, Good RJ, Skillman HE, Czaja AS. Enteral nutrition practices in critically ill children requiring noninvasive positive pressure ventilation. Pediatr Crit Care Med 2017; 18 (12) 1093-1098
• 8 Sánchez C, López-Herce J, Carrillo A, Mencía S, Vigil D. Early transpyloric enteral nutrition in critically ill children. Nutrition 2007; 23 (01) 16-22
• 9 Singer P, Rattanachaiwong S. To eat or to breathe? The answer is both! Nutritional management during noninvasive ventilation. Crit Care 2018; 22 (01) 27
• 10 Joffe A, Anton N, Lequier L. et al. Nutritional support for critically ill children. Cochrane Database Syst Rev 2016; 5 (05) CD005144
• 11 Srinivasan V, Hasbani NR, Mehta NM. et al; Heart and Lung Failure-Pediatric Insulin Titration (HALF-PINT) Study Investigators. Early enteral nutrition is associated with improved clinical outcomes in critically ill children: a secondary analysis of nutrition support in the heart and lung failure-pediatric insulin titration trial. Pediatr Crit Care Med 2020; 21 (03) 213-221
• 12 Mikhailov TA, Gertz SJ, Kuhn EM, Scanlon MC, Rice TB, Goday PS. Early enteral nutrition is associated with significantly lower hospital charges in critically ill children. JPEN J Parenter Enteral Nutr 2018; 42 (05) 920-925
• 13 Gorelick MH, Stevens MW, Schultz TR, Scribano PV. Performance of a novel clinical score, the Pediatric Asthma Severity Score (PASS), in the evaluation of acute asthma. Acad Emerg Med 2004; 11 (01) 10-18
• 14 Mehta NM. Early enteral nutrition in the PICU: should we trust our gut?. Pediatr Crit Care Med 2015; 16 (08) 786-789
• 15 Ghetas HM, Elshafie A, El-Lahony D, Omar Z, Bahbah W. Nutrition in critically Ill pediatric patients: a systemic review. Menoufia Med J 2019; 32: 812-817
• 16 Larsen BMK, Beggs MR, Leong AY, Kang SH, Persad R, Garcia Guerra G. Can energy intake alter clinical and hospital outcomes in PICU?. Clin Nutr ESPEN 2018; 24: 41-46
• 17 Canarie MF, Barry S, Carroll CL. et al; Northeast Pediatric Critical Care Research Consortium. Risk factors for delayed enteral nutrition in critically ill children. Pediatr Crit Care Med 2015; 16 (08) e283-e289
• 18 Terzi N, Darmon M, Reignier J. et al; OUTCOMEREA study group. Initial nutritional management during noninvasive ventilation and outcomes: a retrospective cohort study. Crit Care 2017; 21 (01) 293
• 19 Bendavid I, Singer P, Theilla M. et al. NutritionDay ICU: a 7 year worldwide prevalence study of nutrition practice in intensive care. Clin Nutr 2017; 36 (04) 1122-1129
• 20 Tume LN, Eveleens RD, Mayordomo-Colunga J. et al. Enteral feeding of children on noninvasive respiratory support: a four-center European study, Pediatr Crit Care Med. 2020 Doi: 10.1097/PCC.0000000000002602
• 21 Amantéa SL, Piva JP, Sanches PR, Palombini BC. Oropharyngeal aspiration in pediatric patients with endotracheal intubation. Pediatr Crit Care Med 2004; 5 (02) 152-156
• 22 Haney A, Burritt E, Babbitt CJ. The impact of early enteral nutrition on pediatric acute respiratory failure. Clin Nutr ESPEN 2018; 26: 42-46
• 23 Slain KN, Martinez-Schlurmann N, Shein SL, Stormorken A. Nutrition and high-flow nasal cannula respiratory support in children with bronchiolitis. Hosp Pediatr 2017; 7 (05) 256-262
• 24 Beggs S, Wong ZH, Kaul S, Ogden KJ, Walters JAE. High-flow nasal cannula therapy for infants with bronchiolitis. Cochrane Database Syst Rev 2014; 1 (01) CD009609
• 25 Mayfield S, Jauncey-Cooke J, Hough JL, Schibler A, Gibbons K, Bogossian F. High-flow nasal cannula therapy for respiratory support in children. Cochrane Database Syst Rev 2014; 3 (03) CD009850