Department of Pediatric Critical Care, Toulouse Children's University Hospital, 31300 Toulouse, France.
Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada.
Nutrients. 2023 Jun 20;15(12):2817. doi: 10.3390/nu15122817.
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%; < 0.01), and they occurred earlier during ICU admission (0 vs. 2 days; < 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; < 0.01), receiving a higher fraction of inspired oxygen (FiO) (0.42 vs. 0.35; = 6; = 0.03), and with lower oxygen saturation (SpO) (91% vs. 97%; = 0.8; < 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; = 1.12; < 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.
在儿科重症监护病房（PICU）中，使用无创通气（NIV）来支持呼吸衰竭的儿童并避免气管插管的做法有所增加。目前的指南建议在入院后 24-48 小时内开始肠内营养（EN）。由于缺乏安全性数据和潜在的呼吸道和胃并发症增加的认知，这种做法在各 PICU 之间存在差异。本回顾性研究的目的是评估在接受 NIV 治疗急性呼吸衰竭的 0-18 岁儿童中，EN 与肠外并发症发展之间的关联。在接受 NIV 支持的 332 名患者中，249 名（75%）在入院的前 48 小时内接受了肠内喂养。在总队列中，有 132 名（40%）发生了呼吸并发症，主要发生在未进行肠内喂养的患者中（60/83，72% vs. 72/249，29%；<0.01），并且它们在 ICU 入院期间更早发生（0 天 vs. 2 天；<0.01）。大多数并发症是吸入氧分数（FiO）的变化（220/290，76%）。在多变量评估中，接受双水平气道正压通气（BiPAP）的儿童（23/132，17% vs. 96/200，48%；比值比[OR] = 5.3；<0.01）、接受更高 FiO（0.42 与 0.35； = 6； = 0.03）和更低氧饱和度（SpO）（91%与 97%； = 0.8；<0.01）的儿童更有可能发生并发症。有并发症的患者从 ICU 出院的时间更长（11 天 vs. 3 天； = 1.12；<0.01）。在 ICU 稳定的初始阶段后，需要接受 NIV 的大多数患者都可以进行肠内喂养，而不会增加呼吸并发症。
