Tube feeding in patients on Bipap

[Rho]

In our ICU it has been the practice to hold NG feeds in patients on
Bipap. Is there any evidence for this practice? If it is accepted
practice, does change for patients with small bowel tubes in place?

Thanks

Rhona Nayman RD.

[Jessica Younkman]

We will typically hold TF mainly due to the possibility of intubation as the patient is so unstable.  But also, the Bipap can fill the stomach with with air and cause abd distention; which if fed into the stomach can cause upset.  If a patient remains on bipap a few days, we will start the tf via NGT/small bore tube and monitor closely for tolerance. 

I have no experience with Bipap and small bowel tubes. 
Hope this helps. 
 

[PJ]

We tube feed patients via the gastric route on prolonged BIPAP support
with no apparent GI intolerance. We do try to use a relatively small
tube french size to minimize the break in the seal of the BIPAP mask
around the patient's face. At our hospital, for now, the practice is
to hold TF if the gastric residual is > 250 ml or if there is frank
emesis or abdo distension.
Hope this helps.

Paul Morretti, RD, MSc., CNSD

[Shyam]

Presently there are no guidelines nor any evidence regarding NG feeds
in patients on Bipap { NIV}.
I normally hold the feeds for patients who are put on NIV for the
initial few hours , during which time i make an assessment of whether
the NIV would be successful or the patient would require intubation.
If the clinical status of the patient improves , i initiate small
quantity, continuous feeds, slowly increasig the amounts to meet the
required quantity.
Some people start Parental nutrition in patients on NIV, but i have no
experience with this...