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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,...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
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.
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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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