Impact of Feeding Status on Biochemical and Respiratory Parameters in Ventilator-Dependent Patients

餵食狀況對呼吸器依賴患者血液生化值及呼吸參數之影響

林慶雄(Ching-Hsiung Lin) ； 羅慧珍(Hui-Chen Lo) ； 邱伯勤(Bo-Chin Chiou)

《胸腔醫學》 17卷1期 (2002/03) Pp. 10-18

摘要

Meeting the adequate nutritional requirements of ventilator-dependent patients is still a challenge, because of the variety and severity of the diseases of these patients and the lack of reliable nutritional support guidelines. The objective of this study was to compare the energy requirement, biochemical data, and respiratory parameters in ventilator-dependent patients fed with different amounts of calories. Twenty-eight patients who had been on mechanical ventilation more than 14 days, with various primary diagnoses, and on continuous nasogastric tube feeding, were recruited. Resting energy expenditure (REE) was measured by indirect calorimetry (IC). Total energy expenditure (TEE) was defined as 1.2-fold of REE. Degree of feeding (DF) was defined as the ratio of actual calories provided to TEE. Our results showed that there were 5 patients (group A) with under- (DF ＜ 0.9) or appropriate feeding (0.9 £ DF £ 1.1), and 23 patients (group B) with overfeeding (DF ＞ 1.1) in this study. There were no significant differences in the serum levels of glucose, albumin, blood urea nitrogen, creatinine, prealbumin, transferrin, C-reactive protein, and nitrogen balance between group A and group B. The results of the complete blood count, blood gas, nutrient intake, tidal volume, respiratory rate, and minute ventilation were not significantly different between two groups. However, the proportional contribution of the energy substrate from carbohydrates was significantly greater in patients with overfeeding. In addition, patients with overfeeding had significantly lower carbon dioxide production, oxygen consumption, and REE, and had significantly higher levels of respiratory quotient (RQ) and non-protein RQ than the other patients. These results suggest that most of the ventilator-dependent patients in this study were overfed and had decreased fat oxidation. The use of IC may reduce the incidence of inappropriate feeding. Even though we found there were no significant effects of overfeeding in the biochemical data and respiratory parameters, the risks of overfeeding and the waste of medical resources are still worthy of consideration.

關鍵字

呼吸器依賴 ； 休息熱量消耗 ； 間接熱量測定 ； 呼吸參數

並列摘要

Meeting the adequate nutritional requirements of ventilator-dependent patients is still a challenge, because of the variety and severity of the diseases of these patients and the lack of reliable nutritional support guidelines. The objective of this study was to compare the energy requirement, biochemical data, and respiratory parameters in ventilator-dependent patients fed with different amounts of calories. Twenty-eight patients who had been on mechanical ventilation more than 14 days, with various primary diagnoses, and on continuous nasogastric tube feeding, were recruited. Resting energy expenditure (REE) was measured by indirect calorimetry (IC). Total energy expenditure (TEE) was defined as 1.2-fold of REE. Degree of feeding (DF) was defined as the ratio of actual calories provided to TEE. Our results showed that there were 5 patients (group A) with under- (DF ＜ 0.9) or appropriate feeding (0.9 £ DF £ 1.1), and 23 patients (group B) with overfeeding (DF ＞ 1.1) in this study. There were no significant differences in the serum levels of glucose, albumin, blood urea nitrogen, creatinine, prealbumin, transferrin, C-reactive protein, and nitrogen balance between group A and group B. The results of the complete blood count, blood gas, nutrient intake, tidal volume, respiratory rate, and minute ventilation were not significantly different between two groups. However, the proportional contribution of the energy substrate from carbohydrates was significantly greater in patients with overfeeding. In addition, patients with overfeeding had significantly lower carbon dioxide production, oxygen consumption, and REE, and had significantly higher levels of respiratory quotient (RQ) and non-protein RQ than the other patients. These results suggest that most of the ventilator-dependent patients in this study were overfed and had decreased fat oxidation. The use of IC may reduce the incidence of inappropriate feeding. Even though we found there were no significant effects of overfeeding in the biochemical data and respiratory parameters, the risks of overfeeding and the waste of medical resources are still worthy of consideration.

並列關鍵字

ventilator-dependent ； resting energy expenditure ； indirect calorimetry ； respiratory parameter