(380) Enteral Nutrition Plus NIV Not Associated With NIV Failure: Results of a Pediatric Multicenter Study

Introduction: Non-invasive ventilation (NIV) use has been on the rise and is often used to decrease need for potentially harmful invasive mechanical ventilation. NIV is often complicated by interface intolerance or need for sedation. Enteral nutrition may be limited to minimize risk for aspiration while on NIV, though this risk has been demonstrated to be low and feeding can potentially decrease agitation. We hypothesize that feeding may decrease overall sedation requirements during NIV and we aimed to investigate cumulative sedation requirements in patients being fed versus not fed. Preliminary results from a secondary aim looking at rates of NIV failure, defined as escalation to invasive ventilation in this population, will be presented here.

Methods: A retrospective chart review was conducted of children aged 0-18 in 11 U.S. Pediatric Intensive Care Units (PICUs) from April 1, 2019 - March 31, 2020 acutely supported with NIV for at least 12 hours. Daily feeding, sedation, and NIV data was collected until subjects were either transferred out of the PICU, weaned off NIV, required intubation, or completed a max of 5 study days; whichever came first.

Results: Preliminary results included 1461 participants with n=86 (6%) requiring intubation. Of those who failed, n=22 were fed and n=64 were not fed. Of those who did not fail, n=891 were fed and n=484 were not fed. The odds of failing NIV if fed were significantly lower (OR= 0.19, 95% CI [0.12-0.3] p< 0.0001) compared to those not fed.

Conclusions: The NIV failure rate in this large group was less than half of what was previously documented in a recent randomized control trial looking at NIV use. Furthermore, looking at exposures prior to NIV failure, feeding was not associated with increased odds of NIV failure. While our final study results will explore further associations between feeding, route of feeding, and sedation during NIV, these preliminary results support that feeding was not associated with increased risk of intubation. There is limited data reporting outcomes of patients on NIV in the pediatric critical care population and further investigation into these associations is ongoing.