Nuestros grandes olvidados, los enfermos respiratorios crónicos

Abstract

Lung's own properties make that nutritional support, besides covering the requirements can modulate its infl ammatory response. Lung tissue has a low glucose stock. Fatty acids are the main energy producer of type II pneumocytes, which use them in order to form phospholipids, essential for surfactant whose creation and release decrease in acute lung injury (ALI). Glutamine is a good substratum for endocrine cells and type II pneumocytes. Due to high nutritional risk, it is important its assessments in disorders as COPD and acute respiratory distress syndrome (ADRS). Indirect calorimetry values the effect of ventilation and nutritional support, avoiding overfeeding. Hypophosphatemia and refeeding syndrome are frequent and need to be avoided because of their morbidity. In critically ill patients, malnutrition can lead to respiratory failure and increasing mechanical ventilation time. To avoid hypercapnia in weaning, glucose levels should be controlled. High lipids/carbohydrates ratio do not show usefulness in COPD neither mechanical ventilation removal. ALI patients benefi ciate from an early start and the volume administered. Enteral nutrition with high fatty acids ratio (EPA, DHA and γ-linolenic acid) and antioxidants do not show any superiority. Omega-3 fatty acid in parenteral nutrition could modulate infl ammation and immunosuppression in a positive manner. The use of glutamine, vitamins or antioxidants in these patients could be justifi ed. Nuestros grandes olvidados, los enfermos respiratorios crónicos ResumenLas peculiaridades del pulmón hacen que el soporte nutricional, además de cubrir los requerimientos, pueda modular su respuesta infl amatoria. El pulmón tiene mínima capacidad de almacenar glucosa. Los lípidos son el sustrato energético de elección de los neumocitos tipo II que los utilizan para formar fosfolípidos, componentes esenciales del surfactante. Su síntesis y liberación disminuyen en la lesión pulmonar aguda (LPA). La glutamina es un buen sustrato para las células endoteliales y los neumocitos tipo II. La valoración nutricional de los pacientes con EPOC y SDRA es fundamental dado su alto riesgo nutricional. La calorimetría indirecta evalúa la respuesta del soporte nutricional y ventilatorio, evitando la sobrenutrición. La hipofosfatemia del síndrome de realimentación es frecuente y debe evitarse por la morbilidad que conlleva. En críticos, la desnutrición puede mantener la insufi ciencia respiratoria y prolongar el tiempo de ventilación mecánica (VM). En fase de weaning se deberían controlar los aportes de glucosa para evitar la retención de CO 2 . Fórmulas con un alto cociente grasas/hidratos de carbono no han demostrado una clara utilidad en el paciente EPOC ni en la retirada de la VM. Los pacientes con LPA se benefi cian del soporte nutricional precoz y del control del aporte de volumen. Las dietas enterales con alto contenido en grasas (EPA, DHA y γ-linolénico) y antioxidantes no han demostrado superioridad. En nutrición parenteral, las emulsiones con mayor contenido de ácidos gr...

Effects of early standardized enteral nutrition on preventing acute muscle loss in the acute exacerbation of chronic obstructive pulmonary disease patients with mechanical ventilation

“…COPD patients may have a long course of the disease, and the repeated inflammatory consumption may lead to malnutrition. [10] The study has not focused on EN standardization in patients with AECOPD during MV, [11] which might lead to insufficient nutrition, immune function injury, infection, or an increase in death. Therefore, it is important to implement early standardized EN for AECOPD patients with MV.…”

Nutritrauma: A Key Concept for Minimising the Harmful Effects of the Administration of Medical Nutrition Therapy

“…In the stressed critically ill patient, the amount of carbohydrate catabolized for metabolic fuel, and CO 2 production is proportional to the amount administered [15]. CO 2 production is also related to over-prescription of calories [16] and can produce hypercapnia in patients where the pulmonary reserve is limited, increasing days of mechanical ventilation [17]. Moreover, administration of >100% of the calories of resting energy expenditure, estimated by indirect calorimetry, has been shown to be associated with an increased mortality rate.…”