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How interesting to see my work discussed during this #COVIDー19 discussion on lower RQ feeding as treatment modality in respiratory failure. @DrPaulMason <thread> 1/7 https://twitter.com/DrAseemMalhotra/status/1245225579286323203
Small study. We were unable to measure VCO2, so valid criticism as to whether high fat group paCO2 reduction related to lung function rather than feed profile. Theoretical calc of CO2 yield from 55% fat (RQ 0.7) feed from typical 55% carb feed (RQ 1.0) was not insubstantial 2/
Subsequent researchers demonstrated VCO2 reduction with high fat vs high carb feeds in overfed (1.5xBEE) ventilated pts https://link.springer.com/article/10.1007/BF01711897 - but no sig reduction in PaCO2 until weaning (c 54ml.min CO2 reduction). Not a CO2 retainer? No benefit of this feed type 3/
Higher fat supplements proved useful in others with chronic lung disease/CO2 retention. These papers on low RQ diets in cystic fibrosis - a condition with significantly increased REE/ significantly impaired lung function https://europepmc.org/article/med/2051272 and https://onlinelibrary.wiley.com/doi/abs/10.1177/014860719001400147 4/
Gadek and colleagues https://journals.lww.com/ccmjournal/Abstract/1999/08000/Effect_of_enteral_feeding_with_eicosapentaenoic.1.aspx reported some additional respiratory/immune benefits of 2nd gen HF feeds with adjusted lipid profile (reduced FiO2/PEEP/MV/ PMN in BAL). 5/
Current approach to #ICU EN typified by #ASPEN and #ESPEN guidelines reduces need for respiratory feeds. I occasionally add lipid source to feed of CO2 retainers with increased energy needs. Use of propofol helps, too. Typical 15ml.h = 40g fat/360 kcals to daily provision
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Can't end thread without clarifying role of immune nutrition in ventilated patients. Twitterati currently rife recommending fish oils, vitamin D, antioxidant vitamins etc to prevent or treat #COVIDー19 . In reality, each nutrient has a place. But in #ICU? https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012041.pub2/information
