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Initial nutritional management during noninvasive ventilation and outcomes: a retrospective cohort study
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,...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5707783/ https://www.ncbi.nlm.nih.gov/pubmed/29187261 http://dx.doi.org/10.1186/s13054-017-1867-y |
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author | Terzi, Nicolas Darmon, Michael Reignier, Jean Ruckly, Stéphane Garrouste-Orgeas, Maïté Lautrette, Alexandre Azoulay, Elie Mourvillier, Bruno Argaud, Laurent Papazian, Laurent Gainnier, Marc Goldgran-Toledano, Dan Jamali, Samir Dumenil, Anne-Sylvie Schwebel, Carole Timsit, Jean-François |
author_facet | Terzi, Nicolas Darmon, Michael Reignier, Jean Ruckly, Stéphane Garrouste-Orgeas, Maïté Lautrette, Alexandre Azoulay, Elie Mourvillier, Bruno Argaud, Laurent Papazian, Laurent Gainnier, Marc Goldgran-Toledano, Dan Jamali, Samir Dumenil, Anne-Sylvie Schwebel, Carole Timsit, Jean-François |
author_sort | Terzi, Nicolas |
collection | PubMed |
description | 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-017-1867-y) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5707783 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-57077832017-12-06 Initial nutritional management during noninvasive ventilation and outcomes: a retrospective cohort study Terzi, Nicolas Darmon, Michael Reignier, Jean Ruckly, Stéphane Garrouste-Orgeas, Maïté Lautrette, Alexandre Azoulay, Elie Mourvillier, Bruno Argaud, Laurent Papazian, Laurent Gainnier, Marc Goldgran-Toledano, Dan Jamali, Samir Dumenil, Anne-Sylvie Schwebel, Carole Timsit, Jean-François Crit Care Research 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-017-1867-y) contains supplementary material, which is available to authorized users. BioMed Central 2017-11-29 /pmc/articles/PMC5707783/ /pubmed/29187261 http://dx.doi.org/10.1186/s13054-017-1867-y Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Terzi, Nicolas Darmon, Michael Reignier, Jean Ruckly, Stéphane Garrouste-Orgeas, Maïté Lautrette, Alexandre Azoulay, Elie Mourvillier, Bruno Argaud, Laurent Papazian, Laurent Gainnier, Marc Goldgran-Toledano, Dan Jamali, Samir Dumenil, Anne-Sylvie Schwebel, Carole Timsit, Jean-François Initial nutritional management during noninvasive ventilation and outcomes: a retrospective cohort study |
title | Initial nutritional management during noninvasive ventilation and outcomes: a retrospective cohort study |
title_full | Initial nutritional management during noninvasive ventilation and outcomes: a retrospective cohort study |
title_fullStr | Initial nutritional management during noninvasive ventilation and outcomes: a retrospective cohort study |
title_full_unstemmed | Initial nutritional management during noninvasive ventilation and outcomes: a retrospective cohort study |
title_short | Initial nutritional management during noninvasive ventilation and outcomes: a retrospective cohort study |
title_sort | initial nutritional management during noninvasive ventilation and outcomes: a retrospective cohort study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5707783/ https://www.ncbi.nlm.nih.gov/pubmed/29187261 http://dx.doi.org/10.1186/s13054-017-1867-y |
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