Effects of Hypercaloric Feeding on Nutrition Status and Carbon Dioxide Production in Patients With Long-Term Mechanical Ventilation

Abstract

Background: To clarify clinical arguments regarding nutrition support in patients with long-term mechanical ventilation, we investigated the effects of hypercaloric feeding on nutrition status and carbon dioxide production. Methods: Twenty-eight mechanically ventilated, clinically stable patients with nasogastric tube feeding were recruited and randomly divided into the control and hypercaloric groups, which were provided with 1.2- and 1.8-fold of resting energy expenditure (REE), respectively. The arterial and venous blood samples were collected, the anthropometric measurements were determined, the serum concentrations of nutrition-related proteins were measured, and the parameters on the ventilator and indirect calorimeter were recorded on weeks 0, 2, and 4. Results: There were no significant changes in anthropometric measurements, blood gas tensions, and REE between the control and hypercaloric groups during the experimental period (mixed model with repeated measures analysis, p < .05). After adjusted for values on week 0 and time, patients with hypercaloric feeding had significantly increased levels in white blood cells, hemoglobin, and hematocrit. However, the control group had significantly decreased and the hypercaloric group had significantly increased serum concentrations of prealbumin and transferrin, rate of carbon dioxide production, and respiratory quotient (RQ) from week 0 to week 4. Conclusion: Our results suggest that 4 weeks of hypercaloric feeding may significantly increase the production of carbon dioxide but may not significantly alter the clinical outcomes in patients with long-term mechanical ventilation. The adverse effects of hypercaloric feeding may easily be overlooked, and the appropriateness of nutrition support should be carefully monitored in patients with mechanical ventilation.

We assessed the effects of hypercaloric feeding (1.8-fold of resting energy expenditure) on anthropometric measurements, biochemical analysis, and energy expenditure in patients with mechanical ventilation. The results showed that hypercaloric feeding significantly increases CO₂ production. However, the unchanged results in clinical examinations may cover up the adverse effects of moderate hypercaloric feeding.

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References

Ireton-Jones CS, Borman KR, Turner WW. Nutrition considerations in the management of ventilator-dependent patients. Nutr Clin Pract. 1993;8:60– 64.

Takiguchi SA. Report of a hidden case of overfeeding. Heart Lung. 1990;19:639– 640.

Cutts ME, Dowdy RO, Ellersieck MR, Edes TE. Predicting energy needs in ventilator-dependent critically ill patients: effect of adjusting weight for edema or adiposity. Am J Clin Nutr. 1997 ;66:1250– 1256.

McClave SA, Lowen CC, Kleber MJ, et al. Are patients fed appropriately according to their caloric requirements? JPEN J Parenter Enteral Nutr. 1998;22:375– 381.

Alberda C, Snowden L, McCargar L, Gramlich L. Energy requirements in clinically ill patients: how close are our estimates? Nutr Clin Pract. 2002;17:38– 42.

Joosten KFM, Verhoeven JJ, Hazelzet JA. Energy expenditure and substrate utilization in mechanically ventilated children.Nutrition. 1999;15:444– 448.

Dark DS, Pingleton SK, Kerby GR. Hypercapnia during weaning: a complication of nutritional support. Chest. 1985 ;88:141– 143.

Liggett SB, Renfro AD. Energy expenditure of mechanically ventilated nonsurgical patients. Chest. 1990 ;98:682– 686.

Klein CJ, Stanek GS, Wiles CE 3rd. Overfeeding macronutrients to critically ill adults: metabolic complications. J Am Diet Assoc. 1998;98:795– 806.

10.

van den Berg B, Stam H. Metabolic and respiratory effects of enteral nutrition in patients during mechanical ventilation. Intensive Care Med. 1988;14:206– 211.

11.

Lin C-H, Lo H-C, Chiou B-C. Impact of feeding status on biochemical and respiratory parameters in ventilator-dependent patients. Thorac Med. 2002;17:10– 18.

12.

Topping MD, Forster HW, Dolman C, Luczynska CM, Bernard AM. Measurement of urinary retinol-binding protein by enzyme-linked immunosorbent assay, and its application to detection of tubular proteinuria. Clin Chem. 1986;32:1863– 1866.

13.

Branson RD. The measurement of energy expenditure: instrumentation, practical considerations, and clinical application. Respir Care. 1990;35:640– 659.

14.

Matarese LE. Indirect calorimetry: technical aspects. J Am Diet Assoc. 1997;97(suppl):S154– S160.

15.

Ambrosino N, Clini E. Long-term mechanical ventilation and nutrition. Respir Med. 2004 ;98:413– 420.

16.

McDevitt RM, Bott SJ, Harding M, Coward WA, Bluck LJ, Prentice AM. De novo lipogenesis during controlled overfeeding with sucrose or glucose in lean and obese women. Am J Clin Nutr. 2001 ;74:737– 746.

17.

Jebb SA, Prentice AM, Goldberg GR, Murgatroyd PR, Black AE, Coward WA. Changes in macronutrient balance during over- and underfeeding assessed by 12-d continuous whole-body calorimetry. Am J Clin Nutr. 1996 ;64:259– 266.

18.

Aarsland A, Chinkes D, Wolfe RR. Hepatic and whole-body fat synthesis in humans during carbohydrate overfeeding. Am J Clin Nutr. 1997;65:1774– 1782.

19.

Koretz RL. The calorie conundrum. JPEN J Parenter Enteral Nutr. 2002;26:182– 183.

20.

Kleber MJ, Lowen CC, McClave SA, Jung LY, Looney SW. Is there a role for indirect calorimetry in maximizing patient outcome from nutritional alimentation in the long-term nursing care setting? Nutr Clin Pract. 2000;15:227– 232.

21.

McClave SA, Snider HL. Use of indirect calorimetry in clinical nutrition. Nutr Clin Pract. 1992 ;7:207– 221.

22.

McClave SA, Lowen CC, Kleber MJ, et al. Is the respiratory quotient a useful indicator of over or underfeeding? [abstract] JPEN J Parenter Enteral Nutr 1997;21(suppl):S11 .

23.

McClave SA, McClain CJ, Snider HL. Should indirect calorimetry be used as part of nutritional assessment? J Clin Gastroenterol. 2001 ;33:14– 19.

24.

Malone AM. Methods of assessing energy expenditure in the intensive care unit. Nutr Clin Pract. 2002 ;17:21– 28.

25.

Tremblay A, Despres JP, Theriault G, Fournier G, Bouchard C. Overfeeding and energy expenditure in humans. Am J Clin Nutr. 1992 ;56:857– 862.

26.

Weyer C, Vozarova B, Ravussin E, Tataranni PA. Changes in energy metabolism in response to 48 h of overfeeding and fasting in Caucasians and Pima Indians. Int J Obes Relat Metab Disord. 2001 ;25:593– 600.

27.

Wooley JA, Sax HC. Indirect calorimetry: applications to practice.Nutr Clin Pract. 2003;18:434– 439.

28.

Holdy KE. Monitoring energy metabolism with indirect calorimetry: instruments, interpretation, and clinical application. Nutr Clin Pract. 2004;19:447– 454.