title: Enteral Nutrition Is a Risk Factor for Airway Complications in Subjects Undergoing Noninvasive Ventilation for Acute Respiratory Failure.
abstract: BACKGROUND
  Early enteral nutrition is recommended for mechanically ventilated patients in several studies and guidelines. In contrast, the effects of early enteral nutrition on noninvasive ventilation (NIV) have not been investigated extensively. The lack of an established method of airway protection suggests that enteral nutrition administration to these patients could increase airway complications and worsen outcomes.
  
  
  METHODS
  Between January 2007 and January 2015, 150 patients were admitted to our respiratory department for acute respiratory failure and received NIV for >48 h. Of these, 107 subjects incapable of oral intake were retrospectively analyzed. Clinical background and complications were compared in subjects who did and did not receive enteral nutrition.
  
  
  RESULTS
  Sixty of the 107 subjects (56%) incapable of oral intake who received NIV also received enteral nutrition. Serum albumin concentration was significantly lower in subjects who received enteral nutrition than in those who did not (mean 2.7 ± 0.68 mg/dL vs 3.0 ± 0.75 mg/dL,P= .048). The rate of airway complications was significantly higher (53% [32/60] vs 32% [15/47],P= .03), and median NIV duration was significantly longer (16 [interquartile range 7-43] d vs 8 [5-20] d,P= .02) in subjects who received enteral nutrition than in those who did not. Multivariate analysis showed that enteral nutrition was unrelated to in-hospital mortality.
  
  
  CONCLUSIONS
  Among subjects receiving NIV, enteral nutrition was associated with increased risk of airway complications but did not affect mortality. Enteral nutrition should be carefully considered in these patients.
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan. m_k_o_g_o@yahoo.co.jp.
authors.forename: Mariko
authors.initials: M
authors.lastname: Kogo
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Nagata
authors.affiliation: Clinical Research Center, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan and the Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Ito
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Teraoka
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
authors.forename: Daichi
authors.initials: D
authors.lastname: Fujimoto
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakagawa
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Otsuka
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Tomii
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D063087:Noninvasive Ventilation / Q000009:adverse effects* / Q000401:mortality; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000150:complications* / Q000628:therapy; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D016896:Treatment Outcome
chemical_list: D012709:Serum Albumin
keywords: airway management; critical care; enteral nutrition; noninvasive ventilation; respiratory care units; respiratory failure