Nutrition Support for the Acute Lung Injury/Adult Respiratory Distress Syndrome Patient: A Review

Abstract

Support for Acute Lung Injury (ALI) and Adult Respiratory Distress Syndrome (ARDS) in many ways represents the summation of all intensive care unit nutrition modalities. Basic tenets of management are based on those established for the general population of mechanically ventilated patients. As a marker of critical illness however, patients with ALI/ARDS suffer from other organ dysfunctions that require advanced support. Specific issues to be considered in this population include carbon dioxide production, prevention of aspiration, and modulation of the inflammatory response. These particular areas, with special attention paid to the role of lipids in ALI/ARDS, will be reviewed.

Nitrogen Balance During Venovenous Extracorporeal Membrane Oxygenation Support: Preliminary Results of a Prospective, Observational Study

“…However, there is debate among nutrition researchers on the role nutrition support during critical illness and ECMO can play on improving short‐ and long‐term outcomes . Overfeeding during critical illness results in increased CO 2 . This increased CO 2 production may hamper weaning of patients receiving VV ECMO.…”

Nutrition and Acute Lung Injury in Critical Care: Focus on Nutrition Care Process

“…The very nature of ALI patients may make reaching enteral nutrition goals difficult. Gastrointestinal dysmotility has been reported in up to 70 % of ventilator-dependent patients (Turner et al 2011). Current guidelines support the use of supplemental parenteral nutrition when nutrient needs cannot be met by the enteral route.…”

“…Indeed, the ASPEN/SCCM guideline for nutrition support therapy in the critically ill adult patient endorses initiating supplemental parenteral nutrition if unable to meet 100 % of the target goal calories after 7-10 days by the enteral route alone (McClave et al 2009). In this context, successful administration of enteral nutrition may be a sign of improvement, and the need for supplemental parenteral nutrition may be a marker of ALI disease severity (Turner et al 2011).…”

“…ALI is characterized by a pro-inflammatory state as well as protein catabolism (Turner et al 2011). Protein catabolism, due to an increase in protein turnover rates, breakdown, and oxygenation of protein, can lead to a loss of lean body mass, especially when combined with underlying diseases such as sepsis or trauma/burn (Mizock 2001).…”

“…ALI may be associated with a direct injury to the lung, such as aspiration, pneumonia, pulmonary contusion, smoke, or toxic gas inhalation, or indirect lung injury resulting from conditions inciting an inflammatory cascade, such as sepsis, traumatic shock, or pancreatitis (Turner et al 2011). ALI is characterized by persistent production of oxygen-free radicals combined with inflammatory mediators that cause a disruption of the lung endothelial and epithelial barriers (Johnson and Matthay 2010).…”