Summary
Nutritional support is an essential component of management in critically ill patients.
Enteral nutrition is an active therapy that attenuates the metabolic response of the organism to stress and favorably modulates the immune system. It is less expensive than parenteral nutrition and is preferred in most cases because of less severe complications and better patient outcomes, including infections, and hospital cost and length of stay.
In the present study we compare between two groups of patients on mechanical ventilation due to respiratory failure on different types of enteral nutrition. One group on standard iso caloric feeding and the other was on high fat,low carbohydrate feeding
The standard isocaloric feeding with carbohydrates (53.3%), fats (30%) and proteins (16.7%) through Ryle tube according to W.H.O. September 1998
The high fat low carbohydrate feeding with carbohydrates (28.1%), fats (55.2%) and proteins (16.7%) also through Ryle tube.
More attention should be paid to the dietary composition of the nutritional support given to patients requiring artificial ventilation for acute respiratory failure. A nutritional regimen with a high fat content may reduce ventilatory requirements and therefore reduce the duration of mechanical ventilation.
This would significantly reduce morbidity and mortality related to complications of mechanical ventilation.
The aim of the current study was to assess the effect of different types of enteral nutrition on duration of mechanical ventilation in patients with respiratory failure
The study was conducted upon 40 consecutive mechanically ventilated patients (21 males &19 females) presented to Critical care department, Benha university hospitals with mean age in group A was 58.5±9.94SD mean while the mean age in group B was 57.35±7.66, during the period from April 2017 to march 2018, included40 patients who fulfilled the selection criteria
All patient were subjective to the following
Initial clinical assessment with daily follow up for signs of improvement or deterioration .clinical assessment included: (blood pressure,,heart rate ,temperature and oxygen saturation)
Demographic data collection including age and gender
Medical histories co morbidities.
Mode of mechanical ventilation.
`CXR and ECG.
Laboratory examination ( CBC- urea ,creatine , ABG, SGPT ,Na ,K ,Mg )
C.T chest (was done to all patients).
In the present study there was significant improvement difference off both clinical and ventilation parameters between the both groups at the end of hospital stay .
we document significant improvement in various biochemical parameters in the form of serum electrolytes and serum albumin in studied group on high fat,low carbohydrate feeding after near accurate calculation of daily caloric requirements and enteral feeding adjusted whether in the form standard diet or high fat ,low carbohydrate diet.
We stress that the nutritional state of the patient is important to shorten the duration of mechanical ventilation in critically ill patients and significant difference in the weaning process and the outcome of the patient
In the future, the research in this field will be focused on, among others: 1) Establishing the real benefits of the different nutrients in different types of diseases and in the different types of stress that affect critically ill patients; 2) Establishing the real benefits of the different elements of immunomodulating foods; 3) Establishing which is the caloric and nitrogen supply needed during the various stages of the stress response (early vs. late), now that the benefits of early enteral nutrition seem to be clearly established; 4) Determining if the initial hyperalimentation of critically ill patients provides real benefits; and 5) Determining if in case of difficulty meeting the nutritional needs with enteral feeding during the first phases, a complementary parenteral nutrition should (or not) be started.
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