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Jakarta, 27 Mar 2009
Nutritional Considerations In Pulmonary Disease
A reciprocal relationship exists between nutrition and pulmonary function. Pulmonary disease frequently leads to nutritional deficits, whereas poor nutritional status can adversely affect lung function. In acute respiratory failure the makeup of the nutritional prescription can have a direct bearing on gas exchange and the ability to wean patients from mechanical ventilation. Specific nutritional interventions depend on the type of respiratory failure present. A fundamental goal of nutritional support is to provide adequate nutrients in a manner that allows optimal pulmonary function.1
Weight loss and erosion of lean body mass are common among individuals with Chronic Obstructive Pulmonary Disease (COPD) and are closely associated with increased morbidity and mortality.2 Researchers have reported elevations in energy expenditure for some patients with COPD in the range of 15% to 20% above normal. According to Harris-Benedict equation, energy needs may be as high as 1.25 times resting energy expenditure in patients with losing weight. Recommended protein intake for patients with stable COPD is 1 to 1.5 g/kg/day.3
Acute Respiratory Distress Syndrome (ARDS) leads to nutritional depletion through the hypermetabolic, catabolic, and inflammatory processes associated with critical illness. Nutritional deficits alter surfactant production, decrease respiratory drives reduce respiratory muscle mass and contractility, and impair immune function, potentially impeding effort to wean patients from mechanical ventilation.4 Energy requirements in ARDS range from 25 to 30 kcal/kg and protein needs are generally 1.5 to 2.0 g/kg/day.
Many patients with pulmonary failure have sufficient gastrointestinal function to allow enteral feeding when oral intake cannot meet nutritional requirements. Enteral formula enriched with the long chain Polyunsaturated Fatty Acids (LC-PUFAs), eicosapentaenoic acid (EPA) and γ-linolenic acid (GLA), and antioxidants, including vitamin E, vitamin C, carotenes, selenium, and taurine, can have favorable effects on clinical outcomes in patients with ARDS.5
Potential for overfeeding is greatest with parenteral nutrition in patients with COPD and ARDS, so the number of calories provided by the formula, especially the quantity of carbohydrate calories, deserves close attention and the carbohydrate infusion rate should remain less than 5 mg/kg/min.3
Malnutrition frequently accompanies pulmonary disease, reducing quality of life and increasing mortality. The metabolic alterations that occur in both acute and chronic pulmonary failure may be influenced by the type and quantity of nutrients provided, so therapeutic goals for nutritional support in pulmonary failure should strive to achieve optimal nutritional status by providing a balanced nutritional prescription that avoid overfeeding.
References :
- Armenti VT, Worthington P. Nutritional Implications of Selected Medical Conditions – Practical Aspects of Nutritional Support – by Patricia H.Worthington, Elsevier Saunders 2004.
- Schols AM, Wouters EF. Nutritional abnormalities and supplementation in chronic obstructive pulmonary disease, Clin Chest Med 21(4):753-762, 2000.
- Hogg J, Klapholz A, Reid-Hector J. Pulmonary disease. In Gottschlich MM, editor : The science and practice of nutrition support, Dubuque, Iowa, 2001, Kendall/Hunt.
- Mizock BA. Nutritional support in acute lung injury and acute respiratory distress syndrome, Nutr Clin Pract 16(6):319-328, 2001.
- Gadek JE et al. Effect of enteral feeding with eicosapentaenoic acid, gamma-linelenic acid, and antioxidants in patients with acute respiratory distress syndrome, Crit Care Med 27(8):1409-1420, 1999.
Philip Darmawan, MD., MKT.
Medical Advisor
Email : pdsony@ho.otsuka.co.id
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