Effect of nutritional support on weaning patients off mechanical ventilators

The provision of adequate nutritional support to ventilator patients (VP), although important, is still overlooked in many hospitals. All VP in our intensive care unit from July 1977 to June 1979 were reviewed; only those who were on ventilators for 3 or more days (range 3-25) were included, but those ventilated after cardiac arrest with possible brainstem damage were excluded. Group A included 33 VP (22 surgical, 11 medical) who received a protein-free, energy-deficient routine IV diet (1650 kJ/day as dextrose in water or electrolyte solution); group B had 14 VP who received nutritional support as TPN or nasogastric tube feeding (8300-12600 kJ/day with optimum nitrogen). In group A, 18 (54.5%) of the 33 VP were able to be weaned off the ventilator compared to 13 (92.8%) of the 14 VP in group B (p less than 0.05). Of medical VP, 10 (90.9%) of 11 in group A were weaned compared with 3 (100%) of 3 in group B (not significant). However, of surgical VP, only 8 (36.3%) of 22 in group A were able to be weaned off mechanical ventilation compared with 10 (90.9%) of 11 in group b (p less tha 0.01); this was likely highly significant in surgical patients because of greater metabolic demand for wound healing and more severe sepsis.