(379) Safety of Enteral Nutrition on Noninvasive Ventilation in Critically Ill Pediatric Patients

Introduction: Enteral nutrition (EN) benefits critically ill children and initiation is suggested within 48 hours of ICU admission. Non-invasive positive pressure ventilation (NIPPV) is a risk for delayed EN. Studies of EN practices for NIPPV patients are limited, often including those on high flow nasal cannula (HFNC). We studied the practices and safety of EN on NIPPV excluding HFNC, an understudied population that rarely feeds orally and is higher risk for aspiration or intubation. With growing use of NIPPV, optimizing nutritional practice is key.

Methods: This is a retrospective review of children requiring NIPPV admitted to a single PICU. We excluded those with home NIPPV use and abdominal contraindications to EN. Patient demographics, diagnoses, respiratory support level, sedation, route/timing of feeds and complications of feeding tube misplacement, emesis, aspiration, intubation and death were reviewed.

Results: In 405 NIPPV runs, patients were aged 0-18 years (median 4) and 74% had chronic co-morbidities. The most common diagnoses were pneumonia, bronchiolitis and status asthmaticus. BiPAP was 89% of NIPPV runs with mean duration 2.8 days, median 1.3 days. 23% were intubated prior to NIPPV, 15% were intubated after NIPPV and 62% were never intubated. 60% received continuous sedation, mostly with dexmedetomidine. 35% received EN while on NIPPV with median of 23 hours for initiation. 80% reached goal feeds in a median of 41 hours. EN route was 55% post-pyloric and 42% gastric via 63% temporary and 37% pre-existing feeding tubes. Pre-existing tubes and continuous sedation both increased odds of receiving EN. Feeding tube misplacements occurred: 1 airway and 32 malpositioned in the GI tract. Emesis occurred in 27 runs with documented aspiration in 2. 62 runs ended in intubation and 11 in death, but none were attributed to feeding, emesis or aspiration.

Conclusions: For most NIPPV runs, EN was not given. When given, EN was often initiated within 24 hours via post-pyloric tube. Complications such as tube misplacement and emesis occurred, but clinical aspiration was very rare and intubation or death attributable to EN did not occur. Our study suggests potential safety of EN on NIPPV. Prospective, multi-center studies on the safety of EN and NIPPV are needed.