Nutrition practices in critically ill adults receiving noninvasive ventilation: A quantitative survey of Australian and New Zealand intensive care clinicians.

BACKGROUND: Noninvasive ventilation (NIV) is frequently used in the intensive care unit (ICU), yet there is a paucity of evidence to guide nutrition management during this therapy. Understanding clinicians' views on nutrition practices during NIV will inform research to address this knowledge gap. OBJECTIVE: The objective of this study was to describe Australian and New Zealand clinicians' views and perceptions of nutrition management during NIV in critically ill adults. METHODS: A cross-sectional quantitative online survey of Australian and New Zealand medical and nursing staff with ≥12 months ICU experience was disseminated through professional organisations via purposive snowball sampling from 29 August to 9 October 2022. Data collection included demographics, current practices, and views and perceptions of nutrition during NIV. Surveys <50% complete were excluded. Data are represented in number (%). RESULTS: A total of 152 surveys were analysed; 71 (47%) nursing, 69 (45%) medical, and 12 (8%) not specified. There was limited consensus on nutrition management during NIV; however, most clinicians (n = 108, 79%) reported that nutrition during NIV was 'important or very important'. Oral intake was perceived to be the most common route (n = 83, 55%), and 29 (21%) respondents viewed this as the safest. Most respondents (n = 106, 78%) reported that ≤50% of energy targets were met, with gastric enteral nutrition considered most likely to meet targets (n = 55, 40%). Reported nutrition barriers were aspiration risk (n = 87, 64%), fasting for intubation (n = 84, 62%), and nutrition perceived as a lower priority (n = 73, 54%). Reported facilitators were evidence-based guidelines (n = 77, 57%) and an NIV interface compatible with enteral nutrition tube (n = 77, 57%). CONCLUSION: ICU medical and nursing staff reported nutrition during NIV to be important; however, there was a lack of consensus on the route of feeding considered to be the safest and most likely to achieve nutrition targets. Interventions to minimise aspiration and fasting, including an interface with nasoenteric tube compatibility, should be explored.

Nutrition therapy during noninvasive ventilation: oral or enteral?

PURPOSE OF REVIEW: Critical care nutrition guidelines primarily focus on patients receiving invasive mechanical ventilation, yet noninvasive ventilation (NIV) is an increasingly common intervention. The optimal route of nutrition delivery in patients receiving NIV has not been established. This review aims to describe the implications of NIV on the route of feeding prescribed. RECENT FINDINGS: Five small, mostly observational, studies have quantified energy or protein intake in patients receiving NIV in critical care, which demonstrate intake to be poor. No study has assessed the impact of feeding route on outcomes. The predominant route of feeding observed is oral intake, yet nutrition intake via this route is lower than that from enteral or parenteral nutrition. Barriers to oral intake include fasting for intubation, the inability to remove NIV apparatus to eat, breathlessness, fatigue and poor appetite, while barriers to enteral nutrition include the impact of the naso-enteric tube on the mask seal and potential aspiration. SUMMARY: Until evidence to support the optimal route of feeding is developed, patient safety should be the key driver of route selection, followed by the ability to achieve nutrition targets, perhaps utilizing a combination of routes to overcome barriers to nutrition delivery.

The reliability and relative validity of a diet index score for 4-11-year-old children derived from a parent-reported short food survey.

OBJECTIVE: To assess the reliability and relative validity of a diet index score derived from a Short Food Survey (SFS). DESIGN: The thirty-eight-item SFS was designed to assess recent dietary intake of 4-11-year-olds to enable calculation of the Dietary Guideline Index for Children and Adolescents. Reliability was assessed based on two online administrations of the SFS, one week apart. Relative validity was assessed by comparing intakes derived from the SFS with those from the mean of three 24 h recalls. Intra-class correlations, Bland-Altman plots and estimated biases were assessed. Cohen's κ coefficients were used to determine the level of agreement between the two methods. SETTING: Adelaide, Australia. SUBJECTS: Sixty-three parents reported on their children's intake (mean age 7·1 (sd 2·1) years). RESULTS: The intra-class correlation for reliability ranged from 0·43 for dairy foods to 0·94 for beverages, and was 0·92 for total diet index score (all P < 0·01). The intra-class correlation for validity ranged from 0·04 for meat and alternatives to 0·41-0·44 for fruit, beverages and extra foods, and was 0·44 for the total diet index score. The SFS overestimated the mean diet index score by 16 %, and the bias was consistent across levels of compliance. The percentage agreement into tertiles of index scores was 84% between the administrations of the two SFS, but only 43 % when comparing the SFS with the mean of the recalls. CONCLUSIONS: The SFS can provide a consistent estimate of overall compliance to dietary guidelines for children aged 4-11 years, but overestimated the total diet index score by 16 % across all levels of compliance.

Nutrition practices in hospitalized adults receiving noninvasive forms of respiratory support: A scoping review.

The use of noninvasive respiratory support is increasing, with noninvasive ventilation (NIV) and high-flow nasal cannula providing unique barriers to nutrition support. Limited data related to nutrition management for these patients in the intensive care unit (ICU) exist; however, the literature in non-critically ill patients is not well described, and its improvement may help to inform practice within the ICU. Therefore, a scoping review was conducted of MEDLINE, EmCare, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases on August 18, 2022, to identify original publications that included adult patients receiving noninvasive respiratory support in a hospital setting with data related to nutrition management. Data were extracted on study design, population, details of respiratory support, and concepts relating to nutrition management (grouped into nutrition screening, assessment, delivery route, intake, and anthropometry). Eleven studies were included, most of which were small (<100 patients), single-center, observational trials in patients receiving NIV only. Five studies reported results related to route of nutrition and nutrition assessment, two on anthropometry, and one each on quantifying intake and nutrition screening; some studies reported multiple parameters. There was a lack of consensus regarding the ideal method for nutrition assessment and route of nutrition. Oral nutrition was the route most frequently reported, yet calorie and protein delivery via this route were inadequate, and barriers to intake included poor appetite, fatigue, and patient cognition. Future research should address barriers pertinent to this population and the impact of nutrition on outcomes.

Nutrition considerations for patients with persistent critical illness: A narrative review.

Critically ill patients experience high rates of malnutrition and significant muscle loss during their intensive care unit (ICU) admission, impacting recovery. Nutrition is likely to play an important role in mitigating the development and progression of malnutrition and muscle loss observed in ICU, yet definitive clinical trials of nutrition interventions in ICU have failed to show benefit. As improvements in the quality of medical care mean that sicker patients are able to survive the initial insult, combined with an aging and increasingly comorbid population, it is anticipated that ICU length of stay will continue to increase. This review aims to discuss nutrition considerations unique to critically ill patients who have persistent critical illness, defined as an ICU stay of >10 days. A discussion of nutrition concepts relevant to patients with persistent critical illness will include energy and protein metabolism, prescription, and delivery; monitoring of nutrition at the bedside; and the role of the healthcare team in optimizing nutrition support.

Evaluating physiological barriers to oral intake in hospitalized patients: A secondary analysis.

BACKGROUND: Oral intake in hospitalized patients is frequently below estimated targets. Multiple physiological symptoms are proposed to impact oral intake, yet many have not been quantified objectively. AIM: To describe the challenges of objectively measuring physiological nutrition-impacting symptoms in hospitalized patients. METHOD: A secondary analysis of data from a single-center, descriptive cohort study of physiological nutrition-impacting symptoms in intensive care unit (ICU) survivors and general medical patients was conducted. Demographic and clinical characteristics were extracted for patients who completed the original study and collected retrospectively for those who were screened and recruited but did not complete the original study. Reasons for patient exclusion from the original study were quantified from the screening database. Descriptive data are reported as mean ± SD, median [interquartile range], or number (percentage). RESULTS: ICU survivors and general medical patients were screened for inclusion in the original study between March 1 and December 23, 2021. Of the 644 patients screened, 97% did not complete the study, with 93% excluded at screening. Of the 266 ICU survivors and 398 general medical patients screened, 89% and 95% were excluded, respectively. Major exclusion criteria included the inability to follow commands or give informed consent (n = 155, 25%), the inability to consume the easy-to-chew and thin-fluid buffet meal, and imminent discharge (both, n = 120, 19%). CONCLUSION: Understanding physiological factors that drive reduced oral intake in hospitalized patients is challenging. Exclusion criteria required to objectively quantify physiological nutrition-impacting symptoms significantly preclude participation and likely act as independent barriers to oral intake.

Comparison of energy intake in critical illness survivors, general medical patients, and healthy volunteers: A descriptive cohort study.

BACKGROUND: Intensive care unit (ICU) survivors have reduced oral intake; it is unknown whether intake and associated barriers are unique to this group. OBJECTIVE: To quantify energy intake and potential barriers in ICU survivors compared with general medical (GM) patients and healthy volunteers. DESIGN: A descriptive cohort study in ICU survivors, GM patients, and healthy volunteers. Following an overnight fast, participants consumed a 200 ml test-meal (213 kcal) and 180 min later an ad libitum meal to measure energy intake (primary outcome). Secondary outcomes; taste recognition, nutrition-impacting symptoms, malnutrition, and quality of life (QoL). Data are mean ± SD, median (interquartile range [IQR]) or number [percentage]). RESULTS: Twelve ICU survivors (57 ± 17 years, BMI: 30 ± 6), eight GM patients (69 ± 19 years, BMI: 30 ± 6), and 25 healthy volunteers (58 ± 27 years, BMI: 25 ± 4) were included. Recruitment ceased early because of slow recruitment and SARS-CoV-2. Energy intake was lower in both patient groups than in health (ICU: 289 [288, 809], GM: 426 [336, 592], health: 815 [654, 1165] kcal). Loss of appetite was most common (ICU: 78%, GM: 67%). For ICU survivors, GM patients and healthy volunteers, respectively, severe malnutrition prevalence; 40%, 14%, and 0%; taste identification; 8.5 [7.0, 11.0], 8.5 [7.0, 9.5], and 8.0 [6.0, 11.0]; and QoL; 60 [40-65], 50 [31-55], and 90 [81-95] out of 100. CONCLUSIONS: Energy intake at a buffet meal is lower in hospital patients than in healthy volunteers but similar between ICU survivors and GM patients. Appetite loss potentially contributes to reduced energy intake.

Nutrition Management for Critically Ill Adult Patients Requiring Non-Invasive Ventilation: A Scoping Review.

Nutrition management is a core component of intensive care medicine. Despite the increased use of non-invasive ventilation (NIV) for the critically ill, a paucity of evidence on nutrition management precludes recommendations for clinical practice. A scope of the available literature is required to guide future research on this topic. Database searches of MEDLINE, Embase, Scopus, Web of Science, and Google Scholar were conducted to identify original research articles and available grey literature in English from 1 January 1990 to 17 November 2021 that included adult patients (≥16 years) receiving NIV within an Intensive Care Unit. Data were extracted on: study design, aim, population, nutrition concept, context (ICU type, NIV: use, duration, interface), and outcomes. Of 1730 articles, 16 met eligibility criteria. Articles primarily included single-centre, prospective, observational studies with only 3 randomised controlled trials. Key concepts included route of nutrition (n = 7), nutrition intake (n = 4), energy expenditure (n = 2), nutrition status (n = 1), and nutrition screening (n = 1); 1 unpublished thesis incorporated multiple concepts. Few randomised clinical trials that quantify aspects of nutrition management for critically ill patients requiring NIV have been conducted. Further studies, particularly those focusing on the impact of nutrition during NIV on clinical outcomes, are required to inform clinical practice.

Nutrition management of critically ill adult patients requiring non-invasive ventilation: a scoping review protocol.

OBJECTIVE: This scoping review will identify the current available literature and key concepts in the nutrition management of critically ill adult patients requiring non-invasive ventilation. INTRODUCTION: Current international nutrition guidelines include recommendations for the nutrition management of critically ill patients who are receiving invasive mechanical ventilation; however, these guidelines do not address nutrition management of patients receiving non-invasive ventilation. This scoping review aims to explore and describe the existing available literature on the nutrition management of critically ill adults requiring non-invasive ventilation. INCLUSION CRITERIA: This review will consider original research (qualitative, quantitative, or mixed methods studies) reporting on any nutrition parameter for critically ill adult patients (≥16 years) requiring non-invasive ventilation in the intensive care unit. Concepts of interest based on the general intensive care nutrition literature include route of nutrition, recommendations related to macro- or micro-nutrients, nutrition provision, barriers to nutrition provision, and strategies for nutrition management. METHODS: This review will be conducted in accordance with JBI methodology for scoping reviews using a three-step search strategy. MEDLINE, Embase, Scopus, and Web of Science will be searched to obtain original research available in English and published after 1990. Google Scholar will be searched for gray literature. Duplicates will be removed and studies will be selected by two independent reviewers based on the inclusion criteria. The same two reviewers will extract data in duplicate using a data extraction tool. Any disagreements will be resolved via consensus with a third reviewer. Data extraction will be synthesized in tabular and diagrammatic format.