Page 440 - Clinical Application of Mechanical Ventilation

406 Chapter 12

TABLE 12-17 Effects of Undernutrition

1. Depletion of cellular stores of glycogen and protein

2. Fatigue of respiratory muscles

3. Impaired pulmonary function
4. Decreased cell-mediated immunity

5. Interstitial or pulmonary edema
6. Poor wound healing

7. Decreased surfactant production
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Overfeeding

While undernutrition is undesirable for critically ill patients, overfeeding should
High caloric enteric nutri- be avoided. Excessive nutrition may significantly increase the work of breathing
tion can cause a significant
increase in oxygen consump- because of lipogenesis and increased carbon dioxide production. It may also lead to
tion and carbon dioxide diminished surfactant production and fatty degeneration of the liver (Table 12-18)
production. In turn, this can
induce respiratory distress (Ideno et al., 1995).
during weaning for patients High caloric enteric nutrition can cause a significant increase in oxygen consump-
with limited pulmonary
reserve. tion, carbon dioxide production, and respiratory quotient. In turn, this can induce
respiratory distress during weaning for patients with a limited pulmonary reserve.
Problems with overfeeding may also be found in total parenteral nutrition (TPN)
provided via the intravenous route. Respiratory acidosis during mechanical ventilation
has been reported within hours after initiation of TPN (van der Berg et al., 1988).
Low-Carbohydrate High-Fat Diet

Each gram of hydrous dextrose (a form of glucose) produces 3.4 kcal. For the
same amount of fat emulsion, it generates 9.1 kcal. The concentrated source of

TABLE 12-18 Effects of Overfeeding

1. Increased oxygen consumption

2. Increased carbon dioxide production
3. Increased work of breathing

4. Decreased surfactant production

5. Interstitial or pulmonary edema
6. Fatty degeneration of liver
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