Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

The effect of high fat dietary modification and nutritional status on the outcome of critically ill ventilated children: single-center study

  • Received : 2018.08.01
  • Accepted : 2019.03.13
  • Published : 2019.09.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Ventilator dependency constitutes a major problem in the intensive care setting. Malnutrition is considered a major determinant of extubation failure, however, attention has been attracted to modulating carbon dioxide production through decreasing carbohydrate loading and increasing the percent of fat in enteral feeds. The detected interrelation between substrate oxidation and ventilation outcome became the base of several research to determine the appropriate composition of the nonprotein calories of diet in ventilated patients. Purpose: We aimed to assess the effect of high-fat dietary modification and nutritional status on ventilatory and final outcomes of pediatric intensive care. Methods: Fifty-one ventilated children (1 month to 12 years of age) with pulmonary disease who could be enterally fed, in the Cairo University Pediatric intensive care unit, were divided into 2 groups: group A included 25 patients who received isocaloric high-fat, low-carbohydrate diet; group B included 26 patients who received standard isocaloric diet. Comprehensive nutritional assessment was done for all patients. Results: Group A had a significant reduction in carbon dioxide tension, but no similar reduction in the duration or level of ventilatory support. Assisted minute ventilation was predicted by weight-for-age and caloric intake rather than the type of diet. Poor nutritional status was associated with higher mortality and lower extubation rates. Mild hypertriglyceridemia and some gastrointestinal intolerance were significant in group A, with no impact on the adequacy of energy or protein delivery. Conclusion: The high-fat enteral feeding protocol may contribute to reducing carbon dioxide tension, with mild hypertriglyceridemia and negligible gastrointestinal intolerance as potential adverse effects. Optimization of nutritional status rather than dietary modification may improve ventilatory and survival outcomes in critically ill-ventilated children.

Keywords

References

  1. Esquinas AM, editor. Noninvasive mechanical ventilation and difficult weaning in critical care; key topics and practical approaches. Cham (Switzerland): Springer International Publishing, 2016:46.
  2. Askanazi J, Rosenbaum SH, Hyman AI, Silverberg PA, Milic-Emili J, Kinney JM. Respiratory changes induced by the large glucose loads of total parenteral nutrition. JAMA 1980;243:1444-7. https://doi.org/10.1001/jama.1980.03300400028023
  3. Covelli HD, Black JW, Olsen MS, Beekman JF. Respiratory failure precipitated by high carbohydrate loads. Ann Intern Med 1981;95:579-81. https://doi.org/10.7326/0003-4819-95-5-579
  4. Iapichino G. Nutrition in respiratory failure. Intensive Care Med 1989;15:483-5. https://doi.org/10.1007/BF00273555
  5. al-Saady NM, Blackmore CM, Bennett ED. High fat, low carbohydrate, enteral feeding lowers PaCO2 and reduces the period of ventilation in artificially ventilated patients. Intensive Care Med 1989;15:290-5. https://doi.org/10.1007/BF00263863
  6. Faramawy MA, Abd Allah A, El Batrawy S, Amer H. Impact of high fat low carbohydrate enteral feeding on weaning from mechanical ventilation. Egypt J Chest Dis Tuberc 2014;63:931-8. https://doi.org/10.1016/j.ejcdt.2014.07.004
  7. Chumlea WC, Guo SS, Steinbaugh ML. Prediction of stature from knee height for black and white adults and children with application to mobility-impaired or handicapped persons. J Am Diet Assoc 1994;94:1385-8, 1391. https://doi.org/10.1016/0002-8223(94)92540-2
  8. Shahangian S, Agee KA, Dickinson RP. Concentration dependencies of immunoturbidimetric dose-response curves: immunoturbidimetric titer and reactivity, and relevance to design of turbidimetric immunoassays. Clin Chem 1992;38:831-40. https://doi.org/10.1093/clinchem/38.6.831
  9. Food and Agriculture Organization. Energy and protein requirements: report of a joint FAO/WHO/UNU expert consultation. World Health Organization Technical Report Series 724. Geneva (Switzerland): World Health Organization, 1985.
  10. Mehta NM, Compher C; A.S.P.E.N. Board of Directors. A.S.P.E.N. Clinical guidelines: nutrition support of the critically ill child. JPEN J Parenter Enteral Nutr 2009;33:260-76. https://doi.org/10.1177/0148607109333114
  11. Talpers SS, Romberger DJ, Bunce SB, Pingleton SK. Nutritionally associated increased carbon dioxide production. Excess total calories vs high proportion of carbohydrate calories. Chest 1992;102:551-5. https://doi.org/10.1378/chest.102.2.551
  12. van den Berg B, Bogaard JM, Hop WC. High fat, low carbohydrate, enteral feeding in patients weaning from the ventilator. Intensive Care Med 1994;20:470-5. https://doi.org/10.1007/BF01711897
  13. Grippa RB, Silva PS, Barbosa E, Bresolin NL, Mehta NM, Moreno YM. Nutritional status as a predictor of duration of mechanical ventilation in critically ill children. Nutrition 2017;33:91-5. https://doi.org/10.1016/j.nut.2016.05.002
  14. Bechard LJ, Duggan C, Touger-Decker R, Parrott JS, Rothpletz-Puglia P, Byham-Gray L, et al. Nutritional status based on body mass index is associated with morbidity and mortality in mechanically ventilated critically Ill children in the PICU. Crit Care Med 2016;44:1530-7. https://doi.org/10.1097/CCM.0000000000001713
  15. Chaitra KM, Bhavya G, Harish S, Patel S, Anjum SK. Influence of nutritional status on clinical outcomes in critically ill children. Int J Contemp Pediatr 2018;5:462-6. https://doi.org/10.18203/2349-3291.ijcp20180536
  16. Aatif T, Hassani K, Alayoud A, Maoujoud O, Ahid S, Benyahia M, et al. Parameters to assess nutritional status in a Moroccan hemodialysis cohort. Arab J Nephrol Transplant 2013;6:89-97.
  17. Nourmohammadi M, Moghadam OM, Lahiji MN, Hatamian S, Shariatpanahi ZV. Effect of fat-based versus carbohydrate-based enteral feeding on glycemic control in critically Ill patients: a randomized clinical trial. Indian J Crit Care Med 2017;21:500-5. https://doi.org/10.4103/ijccm.IJCCM_118_17
  18. Ong C, Han WM, Wong JJ, Lee JH. Nutrition biomarkers and clinical outcomes in critically ill children: a critical appraisal of the literature. Clin Nutr 2014;33:191-7. https://doi.org/10.1016/j.clnu.2013.12.010

Cited by

  1. Ketogenic Diet for Obese COVID-19 Patients: Is Respiratory Disease a Contraindication? A Narrative Review of the Literature on Ketogenic Diet and Respiratory Function vol.8, 2019, https://doi.org/10.3389/fnut.2021.771047
  2. Ketogenic Diet as a Preventive and Supportive Care for COVID-19 Patients vol.13, pp.3, 2019, https://doi.org/10.3390/nu13031004
  3. The Role of Nutrition in the Prevention and Management of Bronchopulmonary Dysplasia: A Literature Review and Clinical Approach vol.18, pp.12, 2019, https://doi.org/10.3390/ijerph18126245