Nutrition in Pulmonary Stress

Nutrition in Acute Respiratory Distress Syndrome

Pulmonary stress initiates a hypermetabolic, catabolic state. Even when overweight with acute respiratory distress syndrome (ARDS), weight loss should be prevented (AND, 2015a). A secondary goal of nutrition therapy is to prevent overfeeding, which leads to excessive CO2 production that further depresses respiratory function. Protein needs in ARDS and acute lung injury (ALI) are estimated to range from 1.5 to 2.0 g/kg body weight per day (Schwartz 1998). Fluid needs are normal for ARDS and ALI, unless another underlying condition dictates a fluid restriction.

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There is no general consensus regarding the use of immune-enhancing formulas in the enterally fed patient with ARDS and ALI. A number of studies suggest that these patients should receive enteral formulas enriched with dietary fish oil containing eicosapentaenoic acid, borage oil containing gamma-linolenic acid, and higher levels of antioxidant vitamins (Singer et al. 2006), (Pontes-Arruda, Aragao and Albuquerque 2006), (Gadek et al. 1999). The Academy of Nutrition and Dietetics’ evidence analysis project on the topic states the opposite, maintaining that,

“Immune-enhancing enteral nutrition is not recommended for routine use in critically ill patients in the intensive care unit. Immune-enhancing enteral nutrition is not associated with reduced infectious complications, length of stay, reduced cost of medical care, days on mechanical ventilation, or mortality in moderately to less severely ill intensive care unit patients. Their use may be associated with increased mortality in severely ill intensive care unit patients, although adequately-powered trials evaluating this have not been conducted. For the trauma patient, it is not recommended to routinely use immune-enhancing enteral nutrition, as its use is not associated with reduced mortality, reduced length of stay, reduced infectious complications or fewer days on mechanical ventilation” (AND, 2012).

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