The role of nutrition in weaning patients from mechani cal ventilation is receiving increased attention. The net protein catabolism and loss of protein stores that are characteristic of the metabolic response to injury have detrimental effects on skeletal muscle function. Adverse effects of malnutrition on lung function include de creased respiratory muscle function, decreased ventila tory drive, and altered pulmonary defense mechanisms. Nutritional therapy should be considered for patients who are undernourished at the time of initiation of me chanical ventilation as well as for patients who will re quire prolonged ventilatory support. Early administra tion of protein and energy in support of enhanced demands is an important factor in allowing time for stabilization of clinical status, recovery from acute lung injury, and successful weaning from mechanical ven tilation.
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References
1.
Askanazi J., Weissman C., Rosenbaum S., et al. Nutrition and the respiratory system. Crit Care Med1982;10:163-172
2.
Barrocus A., Tretola R., Alonso A.Nutrition and the critically ill pulmonary patient. Respir Care1983;28:50-61
3.
Orme J., Clemmen T.Nutrition in the critical care unit. Med Clin North Am1983;67:1295-1304
4.
Apelgren K., Wilmore D.Nutritional care of the critically ill patient. Surg Clin North Am1983;63:497-507
5.
Brown R., Heizer W.Nutrition and respiratory disease. Clin Pharm1984;3:152-161
6.
Lemoyne M., Jeejeebhoy K.Total parenteral nutrition in the critically ill patient. Chest1986;89:568-575
7.
Pingleton S. , Harmon G.Nutritional management in acute respiratory failure. JAMA1987;257:3094-3099
8.
Pingleton S.Nutritional support in the mechanically ventilated patient. Clin Chest Med1988;9:101-112
9.
Schlichtig R. , Ayres S.Nutritional support of the critically ill . Chicago: Yearbook Medical Publishers , 1988
10.
Sahn S., Lakshminarayan S.Bedside criteria for discontinuation of mechanical ventilation. Chest1973;63:1002-1005
11.
Tobin M., Perez W., Guenther S., et al. The pattern of breathing during successful and unsuccessful trials of weaning from mechanical ventilation. Am Rev Respir Dis1986;134: 1111-1118
12.
Tobin M., Guenther S., Perez W., et al. Konno-mean analysis of rib cage-abdominal motion during successful and unsuccessful trials of weaning from mechanical ventilation. Am Rev Respir Dis1987;135:1320-1328
13.
Milic-Emili J.Is weaning an art or a science?Am Rev Respir Dis1986;134:1107-1108
14.
Sassoon C., Te T., Mahutte C., et al. Airway occlusion pressure—an important indicator for successful weaning. Am Rev Respir Dis1987;135:107-113
15.
Fiastro J., Hahib M., Shon B., et al. Comparison of standard weaning parameters and the mechanical work of breathing in mechanically ventilated patients. Chest1988;94: 232-238
16.
Wensier R., Hunker E., Krumdieck C., et al. Hospital nutrition. A prospective evaluation of medical patients during the course of hospitalization. Am J Clin Nutr1979;32:418-426
17.
Driver A., LeBrun M. latrogenic malnutrition in patients receiving ventilatory support . JAMA1980;244:2195-2196
18.
Koretz R.Breathing and feeding—can you have one without the other? Chest1984;85:298-299
19.
Koretz R.Nutritional support—whether or not some is good, more is not better . Chest1985;88:2-3
20.
Bassili M., Deitel M.Effect of nutritional support on weaning patients off mechanical ventilators . JPEN J Parenter Enteral Nutr1981;5:161-163
21.
Larca L., Greenbaum D.Effectiveness of intense nutritional regimens in patients who fail to wean from mechanical ventilation. Crit Care Med1982;10:247-300
22.
Mattar J., Velasco I., Menagh J., et al. Parenteral nutrition as a useful method for weaning patients from mechanical ventilation (abstract). JPEN J Parenter Enteral Nutr1978;2:50
23.
Racitti A., Babu S., Stahl W., et al. Effects of nutrition on weaning from controlled ventilation in patients with chronic obstruction pulmonary disease (abstract). JPEN J Parenter Enteral Nutr1978;3:27
24.
Ching M., Grossi C., Angers J., et al. The outcome of surgical treatment as related to the response of the serum albumin level to nutritional support. Surg Gynecol Obstet1980;151: 199-202
25.
Arora N., Rochester D.Respiratory muscle strength and maximal ventilation in undernourished patients . Am Rev Respir Dis1982;126:5-8
26.
Arora N., Rochester D.Effect of body weight and muscularity on human diaphragm muscle mass, thickness and area. J Appl Physiol1982;52:64-70
27.
Thurlbeck W.Diaphragm and body weight in emphysema. Thorax1978;33:483-487
28.
Rochester D., Arora N., Braun N.Maximum contractile force of human diaphragm muscle, determined in vivo. Trans Am Clin Climatol Assoc1981;83:200-208
29.
Rochester D., Braun N.Determinants of maximum inspiratory pressure in chronic obstructive pulmonary disease. Am Rev Respir Dis1985;132:42-47
30.
Kelsen S., Ference M., Kapoor S.The effect of prolonged undernutrition on structure and function of the diaphragm . J Appl Physiol1985;58:1354-1359
31.
Lewis M., Sieck G., Fournier M., et al. The effect of nutritional deprivation on diaphragm contractility and muscle fiber size. J Appl Physiol1986 ;60:596-603
32.
Burke R., Levine D., Aszae F.Mammalian motor units: physiological and histochemical correlation. Science1979;174: 709-712
33.
Iscoe S., Dankoff J., Migicovsky R., et al. Recruitment and discharge frequency of phrenic motorneurons during inspiration. Respir Physiol1976;26:113-128
34.
Roussos C., Macklem P.Diaphragmatic fatigue in man. J Appl Physiol1977;43:189-197
35.
Braun N., Rochester D.Muscular weakness and respiratory failure. Am Rev Respir Dis1979;119:123-125
36.
Aubier M., Murciano D., Lecocguic Y., et al. Effect of hypophosphatemia on diaphragmatic contractility in patients with acute respiratory failure. N Engl J Med1985;313:420-424
37.
Gertz J., Hedenstierna G., Hellers G., et al. Muscle metabolism in chronic obstructive lung disease and acute respiratory failure. Clin Sci Mol Med1977 ;52:395-403
38.
Malloy D., Dhingra S., Solven F.Hypomagnesemia and respiratory muscle power. Am Rev Respir Dis1984;129:497-498
39.
Aubier M., Viires N., Piquet J., et al. Effects of hypocalcemia on diaphragmatic strength generation . J Appl Physiol1985;58: 2054-2061
40.
Bilbrey G., Herbin L., Carter N., et al. Skeletal muscle resting membrane potential in potassium deficiency . J Clin Invest1973;52:3011-3018
41.
Kelly S., Rosa A., Field S., et al. Inspiratory muscle strength and body composition in patients receiving total parenteral nutrition therapy. Am Rev Respir Dis1984;130:33-37
42.
Wilson D., Rogers R., Hoffman R.Nutrition and chronic lung disease. Am Rev Respir Dis1985;132:1347-1365
43.
Wilson D., Rogers R.Nutrition and the lung. Curr Pulmonol1987 ;8:211-232
44.
Lewis M., Belman M.Nutrition and the respiratory muscles. Clin Chest Med1988;9:337-348
45.
Lewis M., Belman M., Darr-Uyemua L.Nutritional supplementation in ambulatory patients with chronic obstructive pulmonary disease. Am Rev Respir Dis1987;135:1062-1068
46.
Stauffer J. , Carbone J., Bendoski M.Effects of diet supplementation on anthropometric and laboratory nutritional parameters in malnourished ambulatory patients with severe chronic obstructive pulmonary disease (abstract). Am Rev Respir Dis1986;133:284A
47.
Knowles J., Fairburn M., Wiggs B., et al. Dietary supplementation and respiratory muscle performance in patients with COPD. Chest1988;95:977-983
48.
Wilson D., Rogers R., Sanders M., et al. Nutritional intervention in malnourished patients with emphysema . Am Rev Respir Dis1986;134:672-677
49.
Efthimiou J. , Fleming J., Gomes C., et al. The effect of supplementary oral nutrition in poorly nourished patients with chronic obstructive lung disease. Am Rev Respir Dis1988; 137:1075-1082
50.
Goldstein S. , Thomashaw B., Kvetan V., et al. Nitrogen and energy relationships in malnourished patients with emphysema. Am Rev Respir Dis1988;138:636-644
51.
Doekel R Jr, Zwillich C., Scoggin C., et al. Clinical semi-starvation: depression of hypoxic ventilatory response. N Engl J Med1976;295:358-361
52.
Zwillich C. , Sahn S., Weil J.Effects of hypermetabolism on ventilation and chemosensitivity. J Clin Invest1977;60:900-906
53.
Weissman C. , Askanazi J., Rosenbaum S., et al. Amino acids and respiration. Ann Intern Med1983;98:41-44
54.
Chandra RKCell mediated immunity in nutritional imbalance. Fed Proc1980;39:3088-3092
55.
Good RANutrition and immunity. J Clin Immunol1981 ;1: 1-3
56.
McMurray DN , Loomis SA, Casazzi LJ, et al. Development of impaired cell mediated immunity in mild and moderate malnutrition. Am J Clin Nutr1981;34:68-77
57.
Stiehm ERHumoral immunity in malnutrition. Fed Proc1980;39:3093-3097
58.
Goldstein E. , Lippert W., Warshaver D.Pulmonary alveolar macrophage: defender against bacterial infection of the lung. J Clin Invest1974;54:519-528
59.
Martin TR, Altman LC, Alvares OFThe effects of severe protein-calories malnutrition on anti-bacterial defense mechanisms in the rat lung. Am Rev Respir Dis1983;128: 1013-1019
60.
Niederman MS , Merrill WW, Ferranti RD, et al. Nutritional status and bacterial binding in the lower respiratory tract in patients with chronic tracheostomies. Ann Intern Med1984; 100:795-800
61.
Baker J., Detsky A., Wesson D.Nutrition assessment: a comparison of clinical judgment and objective measurements . N Engl J Med1982;306:969-971
62.
Detsky A., Baker J., Mendelson R., et al. Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients: methodology and comparisons. JPEN J Parenter Enteral Nutr1984;8:153-159
63.
Buzby G., Mullen J., Matthews D., et al. Prognostic nutritional index in gastrointestinal surgery. Am J Surg1980;139:160-167
64.
Blackburn G. , Bistrian B., Maini B., et al. Nutritional metabolic assessment of the hospitalized patient. JPEN J Parenter Enteral Nutr1977;1:11-22
65.
Benotti P., Blackburn G.Protein and caloric or macronutrient metabolic management of the critically ill patient. Crit Care Med1979;7:520-525
66.
Pingleton S.Tailoring nutritional support in acute respiratory failure. J Respir Dis1985;6:27-32
67.
Hunker F., Bruton C., Hunker E., et al. Metabolic and nutritional evaluation of patients supported with mechanical ventilation. Crit Care Med1980 ;8:628-632
68.
Mann S., Westenskow D., Moutchens B.Measured and predicted caloric expenditure in the acutely ill. Crit Care Med1985;13:173-177
69.
Harmon G., Whitman R., Pingleton S.Energy requirements in mechanically ventilated COPD patients (abstract). Am Rev Respir Dis1986;133:203A
70.
Weissman C. , Kemper M., Elwyn D., et al. The energy expenditure of the mechanically ventilated critically ill patient. Chest1986 ;89:254-259
71.
Swinamer D. , Phang P., Jones R., et al. Twenty-four hour energy expenditure in critically ill patients. Crit Care Med1987; 15:637-643
72.
Cataldi-Betcher E., Seltzer M., Slocum B., et al. Complications occurring during enteral nutrition support: a prospective study. JPEN J Parenter Enteral Nutr1983;7:546-552
73.
Wolfe B., Runder M., Nichikawa R., et al. Complications of parenteral nutrition. Am J Surg1986;152:93-99
74.
Sheldon G., Baker C.Complications of nutritional support. Crit Care Med1980;8:35-37
75.
Baker A., Rosenberg I.Hepatic complications of total parenteral nutrition. Am J Med1987;82:489-497
76.
Lakshman K., Blackburn G.Monitoring nutritional status in the critically ill adult. J Clin Monit1986;2:114-120
77.
Silberman HS , Silberman AWParenteral nutrition, biochemistry, and respiratory gas exchange. JPEN J Parenter Enteral Nutr1986;10:151-154
78.
Elwyn D., Kinney J.A unique approach to measuring total energy .expenditure by indirect calorimetry . In: Proceedings of first Ross conference on medical research. Columbus, OH, Ross Research Laboratories, 1980:59-62
79.
Dark D., Pingleton S., Kerby G.Hypercapnia during weaning. Chest1985;88:141-143
80.
Askanazi J. , Elwyn D., Silverberg P., et al. Respiratory distress secondary to high carbohydrate load: a case report. Surgery1980;87:596-598
81.
Covelli H., Black J., Olsen M., et al. Respiratory failure precipitated by high carbohydrate loads . Ann Intern Med1981; 95:579-581
82.
Baker J., Detsky A., Stewart S., et al. Randomized trial of total parenteral nutrition in critically ill patients: metabolic effects of varying glucose-lipid ratios as the energy source. Gastroenterology1984;87:53-59
83.
Herve P., Simonneau G., Girard P., et al. Hypercapnic acidosis induced by nutrition in mechanically ventilated patients: glucose versus fat. CriticalCare Medicine1985;13:537-540
84.
van denBerg B., Stan HMMetabolic and respiratory effects of enteral nutrition in patients during mechanical ventilation. Intensive Care Med1988;14:206-211
85.
Talpers S., Ramberger N., Bunce S., et al. High carbohydrate concentrations do not increase carbon dioxide production in mechanically ventilated patients (abstract). Am Rev Respir Dis1988;137:61A
86.
Takala J., Askanazi J., Weissman C., et al. Changes in respiratory control induced by amino acid infusions . Crit Care Med1988;16:465-469
87.
Skeie B., Askanazi J., Rothkopf M., et al. Intravenous fat emulsions and lung function. Crit Care Med1988;16:183-194
88.
jarnberg P. , Lindholm M., Eklund J.Lipid infusion in critically ill patients . Crit Care Med1981;9:27-31
