Specialized enteral formulas in acute and chronic pulmonary disease

The relationship between pulmonary disease and nutrition is significant. Nutrition support therapy is common in this patient population as a supportive and/or therapeutic measure. Historical reports of adverse respiratory function associated with high parenteral carbohydrate intakes have been the rationale for using high-fat enteral formulas in patients with chronic pulmonary dysfunction. Theoretically, providing a low-carbohydrate formula will reduce carbon dioxide production, result in a reduced respiratory quotient, and lead to associated improvement in pulmonary outcomes. In the patient with acute respiratory distress syndrome, an imbalance of mediators exists, with proinflammatory mediators being dominant, ultimately affecting the disease course. An enteral formula with modified lipids designed to modulate eicosanoid production, and therefore influence the inflammatory cascade, is available. This article reviews the rationale for use of modified enteral formulas in both chronic and acute pulmonary disease, reviews the available studies evaluating the efficacy of these formulas, and provides overall recommendations for the use of specialized enteral formulas in individuals with pulmonary disease.