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High fat, low carbohydrate, enteral feeding in patients weaning from the ventilator
B van den Berg1, J M Bogaard, W C Hop
1Respiratory Intensive Care Unit, University Hospital, Rotterdam, The Netherlands.
Objective:
To study whether high fat, low carbohydrate enteral nutrition could reduce VCO2 in patients during ventilator support and weaning from the ventilator in order to facilitate the weaning process.
Design:
prospective, randomized controlled study.
Setting:
Medical ICU of a university hospital.
Patients:
32 ventilator-dependent patients with a prospect of weaning from mechanical ventilation.
Interventions:
high fat feeding administered to 15 patients and standard isocaloric feeding administered to 17 patients, both in a dosage of 1.5 times basal metabolic rate.
Measurements And Results:
Respiratory and metabolic measurements were obtained both during mechanical ventilation and weaning procedures. High fat feeding was associated with significantly lower RQ values compared with standard feeding; the mean (+/- SEM) RQ values during mechanical ventilation amounted to 0.91 +/- 0.01 and 1.00 +/- 0.02 and during weaning to 0.72 +/- 0.02 and 0.86 +/- 0.02 for high fat and standard nutrition respectively (both p-values < 0.001). High fat feeding reduced the CO2-excretion both during mechanical ventilation and weaning, but only the decrease during weaning proved to be significant; the mean (+/- SEM) CO2-excretion amounted to 0.177 +/- 0.010 and 0.231 +/- 0.011 1/min STPD for the high fat and standard feeding respectively (p < 0.01). No significant differences were found in the PaCO2 during weaning between the two feeding groups.
Conclusion:
High fat, low carbohydrate enteral feeding significantly reduced the RQ values in ventilated patients with decreases in VCO2, but in this study failed to reduce PaCO2 during weaning from the ventilator.