Nutrition Therapy in Patients Requiring Noninvasive Ventilation in the Intensive Care Unit: Feasibility, Tolerance, and Complications

Abstract

Background: Patients requiring noninvasive ventilation (NIV) in the intensive care unit (ICU) are likely to have a high prevalence of malnutrition. Nutrition provision in these patients is of utmost importance; however, data on its feasibility, tolerance, and complications are largely unavailable. Objective: The objective of the study was to assess the prevalence of malnutrition in patients requiring NIV in the ICU and to analyze feasibility, tolerance, and complications of nutrition therapy in this population. Methods: This was a prospective, observational study of consecutive patients requiring NIV admitted to the multidisciplinary ICU of a tertiary care, teaching hospital between April 2017 and November 2017. Baseline nutrition status was assessed using subjective global assessment (SGA). Nutrition requirement calculation and prescription were standardized. All included patients were monitored for pattern of nutrition provision, adequacy of delivery tolerance, and complications. Relevant outcomes such as intubation rates, ICU length of stay (LOS), and mortality were also noted. Results: A total of 34 patients were included in the study. Seventy-six percent of patients (26 out of 34 patients) were malnourished as determined by SGA. The mean Acute Physiology, Age and Chronic Health Evaluation II score was 15.1 ± 6.9. The average time for feed initiation was 12.4 h, and the most common reason for the delay (in 43%) was an impending intubation. The mean percentages of calorie and protein requirement that was delivered by day 3 were 67.2% and 48.3%, respectively. Thirteen patients (38.2%) required continuous nasogastric (NG) feeding, while the others could be fed orally. In 14 patients (41.1%), we were able to achieve 80% or more of target calorie requirement by day 3, and among these patients, the mean percentage of target protein intake that could be achieved was 66.6% by day 3. Feed intolerance was observed only in three patients. One patient had an inadvertent dislodgement of NG tube. Six patients (17.6%) required intubation and three (8.8%) died. Mean ICU LOS was 5.6 ± 3.9 days. Conclusion: Patients requiring NIV in the ICU have a high prevalence of malnourishment. Protocol-driven nutrition delivery is feasible in this population and is well tolerated.