The Implementation of a Feeding Protocol in Patients With Noninvasive Ventilation Improves Enteral Nutrition: The NIVEN Study.

Purpose: There is limited evidence to guide the treatment of enteral nutrition (EN) for children with bronchiolitis who receive biphasic positive airway pressure (BiPAP) support.

Methods: This quality improvement project included patients with bronchiolitis who were supported by BiPAP ventilation. An algorithm to increase EN treatment in those patients was created by stakeholders. Two periods of time were compared: group 1 (January 2023 to August 2023) without nutrition implementation protocol vs group 2 (September 2023 to February 2024) after the protocol was implemented. EN was provided via nasogastric tubes. The project aim was to decrease the mean time to initiation of EN by 50% after the start of BiPAP. Secondary end points were time to reach target calories (100 kcal/kg/d), BiPAP total duration, and the proportion of patients with adverse effects.

Results: For the 102 included patients (48 before and 54 after BiPAP ventilation), the median time to the start of EN decreased from 18 (8-26) hours to 6 (2-8) hours (P < 0.05) Median time to reach calorie goal decreased from 103 (85-120) hours to 48 hours (36-60) (P < 0.05). There were no differences in noninvasive ventilation mean duration. No episodes of aspiration or other adverse effects were documented.

Conclusions: The implementation of a standardized pathway for EN in patients with BiPAP was associated with faster initiation of EN and a shorter time to reaching caloric goals without any observed adverse events. Although our sample was small, the findings suggest that more aggressive enteral feeding should be considered in patients receiving noninvasive ventilation.