Energy and protein intake in critically ill people with respiratory failure treated by high-flow nasal-cannula oxygenation: An observational study

Objectives: High-flow nasal-cannula (HFNC) oxygen therapy is increasingly used in the management of respiratory distress. Since this treatment may be required for many days and may impair nutritional intake, this study planned to observe the energy and protein intake of individuals receiving this therapy.

Methods: Forty consecutive patients requiring HFNC oxygenation after extubation or to prevent intubation from November 2017 to June 2018 were included in the study. Demographics, route of nutrition (oral, enteral, or parenteral), calories and protein prescribed and administered, and complications were noted until discharge. Statistical analysis used χ² or Kruskal-Wallis H test.

Results: HFNC oxygen therapy was applied for 42 d in the 40 participants. Overall, individuals with HFNC oxygenation therapy received 449.5 (interquartile range [IQR], 312-850) kcal/d and 19.25 (IQR, 13.9-33.3) g/d protein. Twenty-one participants treated with enteral nutrition received 387 (IQR, 273-931) kcal/d and 18.5 (IQR, 13.9-33.3) g/d protein, whereas those with oral feeding (n = 13) received higher totals of calories, 600 (IQR, 459-850) kcal/d (P = 0.056), and protein, 22 (IQR, 20-45) g/d (P = 0.005). Four participants received parenteral nutrition alone, providing 543 (IQR, 375-886.5) kcal/d and 8.7 (IQR, 0-20) g/d protein. When parenteral nutrition was administered with enteral nutrition, it provided only 324 (IQR, 290-358) kcal/d. Two participants did not receive any nutritional support. The overall length of stay in the intensive care unit was 8 (IQR, 5-17.5) d. Participants receiving enteral nutrition had a longer stay (14 d; IQR, 8-20) than the oral-diet group (4 d; IQR, 2-10; P < 0.03). The rate of intubation after HFNC therapy was not significantly different between the groups (P = 0.586).

Conclusions: Administration of HFNC oxygen therapy was associated with significant underfeeding. In order to reach optimal caloric and protein intake, parenteral nutrition may be considered.