Individualizing Nutrition in Patients with Acute Respiratory Failure Requiring Mechanical Ventilation

Abstract

Provision of adequate nutrition is recognized as a therapeutic necessity to maintain inspiratory muscle strength and prevent weaning failures in patients with acute respiratory failure requiring mechanical ventilation. Total caloric needs are empirically estimated by calculation of basal energy expenditure and modified by correction factors for concurrent levels of stress. Energy requirements can vary considerably from empiric estimations and may be better defined by indirect calorimetry that measures oxygen consumption and carbon dioxide production. Protein constituents are initiated empirically until patient-specific urea nitrogen excretion is available. The addition of fat emulsion as 20–50 percent of total daily calories limits lipogenesis, prevents excessive carbon dioxide production, and provides a volume-concentrated caloric source to fluid-restricted patients. Manipulation of nutrient composition can improve or impair ventilatory weaning and nutritional rehabilitation. The significance of substrate utilization is reviewed and recommendations for establishing nutritional regimens for mechanically ventilated adults with acute respiratory failure are provided.

Extracto

La provisión de adecuada nutrición es reconocida como una necesidad terapeútica para mantener la fuerza muscular inspiratoria y prevenir fracasos al descontinuar la ventilación mecánica en pacientes con fallo respiratorio agudo que así lo requieren. Los requisitos calóricos totales son estimados empíricamente calculando el consumo de energía basal y son modificados por factures de corrección para niveles de tensión concurrentes. Los requisitos de energía pueden variar considerablemente de las estimaciones empíricas y podrían definirse mejor a través de calorimetría indirecta que mide el consumo de oxígeno y la producción de dióxido de carbono. Los constituyentes protéicos se comienzan empíricamente hasta que la excresión de urea nitrogenada del paciente está disponible. La adición de una emulsión de grasa como 20–50 por ciento de las calorías totales diarias limita la lipogénesis, previene la producción excesiva de dióxido de carbono y provee un volumen concentrado de fuente calórica a pacientes en restricción de l***íquidos. La manipulación de la composición de nutrientes puede mejorar o menoscabar el descontinuar la ventilación mecánica y la rehabilitación nutricional. En este artículo se revisa la importancia de la utilización de sustrato y se proveen recomendaciones para establecer regimenes nutricionales para adultos con fallo respiratorio agudo en ventilación mecánica.

Resume

Le support nutritionnel est devenu une nécessité thérapeutique pour maintenir la force musculaire inspiratoire et ainsi prévenir les difficultés dans un programme de sevrage chez les patients atteints d'un trouble respiratoire aigu requerrant une ventilation mécanique. Les besoins caloriques globaux sont estimés empiriquement par un calcul de la dépense énergétique basale modifié par un facteur de correction pour les niveaux de stress concurrents. Les besoins en énergie peuvent varier considérablement à partir des estimations empiriques. Ils pourraient être mieux définis par calorimétrie indirecte qui mesure la consommation d'oxygène et la production de bioxyde de carbone. Les constituants protéiniques sont débutés empiriquement jusqu'à ce qu'une collecte d'urine de 24 heures soit disponible pour le patient afin de déterminer sa balance azotée. L'addition d'une émulsion de lipides de 20 à 50 pour cent des calories totales quotidiennes limite la lipogénèse, prévient la production excessive de bioxyde de carbone et fournie une source calorique concentrée pour les patients en restriction liquidienne. Globalement, l'usage d'une composition enrichie peut améliorer ou altérer le sevrage du ventilateur et la réhabilitation nutritionnelle. L'importance de l'utilisation de substrats est revue et des recommandations pour établir des régimes nutritifs sont fournies aux adultes ventilés mécaniquement pour insuffisance respiratoire.

Keywords

nutrition respiratory failure basal energy expenditure (BEE)resting energy expenditure (REE)

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