Nutritional management and practices in patients with bronchiolitis on non-invasive ventilation using a total face mask: an international survey in French network.

Bronchiolitis is a major cause of respiratory failure in infants, necessitating non-invasive ventilation (NIV). While total face masks (TFM) are an alternative to nasal interfaces for NIV, they pose unique challenges for enteral feeding due to their design, which can limit airway access and increase the risk of complications. This study aimed to investigate the feeding practices of pediatric intensivists managing bronchiolitis patients using TFM for NIV. A cross-sectional survey (SurveyMonkey® software (San Matteo, California, USA)) was conducted among pediatric intensivists in the Groupe Francophone de Réanimation et d'Urgences Pédiatrique (GFRUP) across four French-speaking countries. The survey, consisting of 11 multiple-choice questions, assessed clinical practices related to TFM use and enteral feeding, including initiation timing, feeding methods, and associated complications. From January 2024 to April 2024, 33 intensivists from 10 units and 4 countries (France, Switzerland, Belgium, Canada) answered the survey. All physicians used routinely TFM with 40% of them using it as a first-line NIV interface. Enteral feeding was commonly initiated within 6 h of TFM initiation, with 72% of clinicians waiting for a stabilization period of 3 to 6 h. The majority (85%) employed gastric feeding, with a low incidence of severe complications reported. Vomiting was the most frequent issue, while aspiration pneumonia was rare.

conclusionsDespite the challenges associated with TFM, enteral feeding is widely practiced among pediatric intensivists, with a cautious approach to initiation and a low complication rate. These findings highlight the need for individualized feeding strategies and further research to optimize feeding practices in this population. WHAT IS KNOWN: • Total face masks (TFM) are increasingly used as an alternative to nasal or naso-buccal interfaces for non invasive ventilation in children. TFM may complicate enteral feeding with limited data available on feeding partances and related complications in this context. WHAT IS NEW: • This multicountry survey reveals taht enteral feeding is commonly implemented in children receiving non invasive ventilation via TFM, typically initiated early after clinical stabilization. The low incidence of severe complications supports the overall safety of this approach when applied with caution.