Nutrition
“…the leading determinants of morbidity and mortality are rooted in behavioral choices related to eating habits, exercise, tobacco, alcohol consumption, and stress reduction. Scientific data consistently provide evidence that diet plays an important role in health promotion and disease prevention. Healthy eating habits—coupled with other healthful lifestyle behaviors—have the potential to reduce the risk of chronic disease.” The role of dietetics professionals in health promotion and disease prevention
Journal American Dietics Assoc. 2002
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“Pulmonary aspiration, or the movement of food or fluid into the lungs, can result in pneumonia or even death. Proper body positioning is essential for everyone.” Try to maintain chest elevation of at least 45 degrees. Overfeeding should be avoided for patients with respiratory failure. Provide adequate but not excessive calories. Adaquate fluid intake and electrolyte balance is important.
Donna Mueller, PhD, RD, FADA in Medical Nutrition Therapy
Selenium deficiency has been associated with increased influenza infection. FluWiki page on Selenium
Precursors to the anti-oxidant Glutathione include NAC and Quercetin.
Hydration is extremely important to health. Dehydration can happen easily due to fevers and infection. Oral Rehydation Solutions are available. Plain water is not as effective. Global manufacturers of pre-packaged Oral Rehydration Salts are listed here… http://rehydrate.org/resources/suppliers.htm
Nutritional Management of Ventilated Patients by Ainsley M. Malone, MS, RD, LD, CNSD Nutritional care for patients with ARDS includes fat and carbohydrate balance, micronutrients, and antioxidant intake.
Conclusion Nutritional support, preferably enteral, is essential when treating ARDS patients. Several considerations, including nutrient requirements, fat and carbohydrate balance, micronutrients, and antioxidant intake, should be addressed in the nutritional care of these challenging patients. An enteral formula supplemented with eicosapentanoic and g-linolenic acids may be a useful treatment option in the management of patients with, or at risk of developing, ARDS.
The nutritional supplement OXEPA by Abbott Laboratories (Ross Products Division) has been shown to reduce the need for mechanical ventilation for ARDS patients. It is given through the stomach wall (enteric) to reduce the risk of choking. I am trying to understand if benefits learned in the intensive care unit can be applied to home care.
Oxepa is designed to modulate inflammation in critically ill patients on mechanical ventilation who exhibit pneumonia, sepsis, systemic inflammation (SIRS), need for supplemental oxygen or mechanical ventilation, acute lung injury/acute respiratory distress syndrome, multiple organ failure, or an APACHE II score >15. Oxepa is a medical food that should be used under medical supervision. It contains elevated antioxidants and a patented oil blend consisting of eicosapentaenoic acid and gamma-linolenic acid. In a prospective, randomized, double-blinded, controlled, multicenter clinical trial (Gadek et al, Critical Care Medicine, 1999), patients who were fed Oxepa as the sole source of nutrition for at least 4 to 7 days demonstrated reduced new organ failures, less time on ventilatory support, decreased length of stay in the intensive care unit, and improved oxygenation. (800) 515–7677
OXEPA is clinically shown to modulate the inflammatory response in critically ill, mechanically ventilated patients. It is appropriate for patients who have sepsis, SIRS (systemic inflammatory response syndrome), ALI (acute lung injury), or ARDS (acute respiratory distress syndrome).
- For tube feeding
- For sole-source nutrition
Sample Feeding Administration shows (remember this is continuous enteral feeding)
Day 1 is 25/ml/hr with a total of 600ml/day that means patient receives (4290*0.60=) 2574mg of GLA the first day, 214.5mg * 12 times per day.
Day 1 is 25/ml/hr with a total of 600ml/day that means patient receives (4550*0.60=) 2730mg of EPA the first day, 227.5mg * 12 times per day.
Day 2 doubles the dosage. 5148mg of GLA per day, 429mg 12 times per day.
Day 2 doubles the dosage. 5460mg of EPA per day, 463.3mg 12 times per day.
Day 3 range maximum 7722mg GLA per day, 643.5mg 12 times per day.
Day 3 range maximum 8190mg EPA per day, 682.5mg 12 times per day.
The GLA content of OXEPA is 1.02 g/8 fl oz (4.29 g/L). = 4290mg/1000mL.
The EPA content of OXEPA is 1.08 g/8 fl oz (4.55 g/L). = 4550mg/1000mL.
A good source of GLA is Borage Oil.
A good source of EPA is Fish Oil.
It would take too many softgel capsules to match the level of the essential fatty acids in Oxepa. Liquid supplements could provide the same dosages. Be certain to read the labels.
Nutritional and Metabolic Support in Pain and Palliative Care in Pain David S. Seres, MD, CNSP, 87 page pdf Immune-Stimulating Nutrients
- Arginine - Promotes T cell-mediated immunity and growth
- Glutamine – Energy source for lymphocytes
- Nucleic Acids – T cell maturation
- Selenium – T cell function
- Vitamin A – T cell function
- Vitamin C – Antioxidant
- Vitamin E – Lymphocyte proliferation, antibody & IL antibody & IL-2 production
- Zn – Thymic function, T cell response, DNA function transcription
It goes on to describe Arginine metabolism in sepsis.
Inflammation – Deleterious Deleterious Effects
- Immunosupressive
- Anti-anabolic/catabolic anabolic/catabolic
- Insulin resistance
- Gluconeogenesis
- Muscle breakdown for amino acids for gluconeogenesis = wasting
- Poor healing/wound and skin breakdown
Inflammation-Modulating Nutrients •Omega-3 fatty acids •Probiotics
Probiotics May Prevent Antibiotic Associated Diarrhea. D’Souza, et al. BMJ, 2002
Summary
- Traditional nutritional markers reflect prognosis but not adequacy of prognosis but not adequacy of nourishment nourishment
- Timing and indications for enteral and parenteral nutrition are not the same parenteral nutrition are not the same
- Specific nutrients and probiotics may have a role in altering outcomes
Glutamine-enriched total parenteral nutrition preserves respiratory immunity and improves survival to a Pseudomonas Pneumonia. PubMedID 10334882
Resources
Americal Society for Parenteral and Enteral Nutrition
Americal Society for Nutrition
International Confederation of Dietetic Associations