1. Nutrition for Patients with Respiratory Stress Chapter 16

2. Respiratory Stress Occurs when gas exchange between the air and blood is impaired May cause hypermetabolism When nutritional needs are not met, fewer nutrients are available to maintain respiratory muscle function. Chronic or acute respiratory stress can lead to –Respiratory failure –Multiple organ failure –Death

3. Respiratory Stress—(cont.) Chronic obstructive pulmonary disease –As many as 60% of patients with chronic obstructive pulmonary disease (COPD) have malnutrition, which is associated with poor outcomes. –Many patients with COPD are hypermetabolic-due to increased breathing rate. –Chronic inflammation increases metabolism and impairs appetite –Anorexia may occur due to anxiety, depression fatigue, changes in taste, excess mucous production, dyspnea, or due decreased oxygen delivery to the GI tract reduced peristalsis and digestion. –Early satiety

4. Respiratory Stress—(cont.) Chronic obstructive pulmonary disease –Early satiety-may be due to flattening of diaphragm and a decrease in abdominal volume or from bloating related to swallowed air-the early satiety also contributes to malnutrition

5. Respiratory Stress—(cont.) Chronic obstructive pulmonary disease—(cont.) –Nutrition therapy oCorrecting or preventing malnutrition is the priority. oHigh-calorie, high-protein diet is used. oHigh calorie diet to deal with hypermetabolism oHigh protein diet to preserve lean body mass and respiratory muscle function oFor patients hospitalized with exacerbation of COPD, calorie needs may be 140% above RMR. oProtein need may be 1.2 g/kg body weight.

6. Ventilator Dependency and Carbohydrate Restriction Patients on ventilator support may benefit from a restricted carbohydrate intake. –Carbohydrates produce more carbon dioxide when they are metabolized than do either proteins or fats. –This creates a greater burden on the lungs.