Korean J Pediatr.  2019 Sep;62(9):344-352. 10.3345/kjp.2018.06835.

The effect of high fat dietary modification and nutritional status on the outcome of critically ill ventilated children: single-center study

• El Koofy N
• Rady HI
• Abdallah S
• Bazaraa HM
• Rabie WA
• El-Ayadi A

• KMID: 2464385
• DOI: http://doi.org/10.3345/kjp.2018.06835

Abstract

BACKGROUND
Ventilator dependency constitutes a major problem in the intensive care setting. Malnutrition is considered a major determinant of extubation failure, however, attention has been attracted to modulating carbon dioxide production through decreasing carbohydrate loading and increasing the percent of fat in enteral feeds. The detected interrelation between substrate oxidation and ventilation outcome became the base of several research to determine the appropriate composition of the nonprotein calories of diet in ventilated patients. PURPOSE: We aimed to assess the effect of high-fat dietary modification and nutritional status on ventilatory and final outcomes of pediatric intensive care.
METHODS
Fifty-one ventilated children (1 month to 12 years of age) with pulmonary disease who could be enterally fed, in the Cairo University Pediatric intensive care unit, were divided into 2 groups: group A included 25 patients who received isocaloric high-fat, low-carbohydrate diet; group B included 26 patients who received standard isocaloric diet. Comprehensive nutritional assessment was done for all patients.
RESULTS
Group A had a significant reduction in carbon dioxide tension, but no similar reduction in the duration or level of ventilatory support. Assisted minute ventilation was predicted by weight-for-age and caloric intake rather than the type of diet. Poor nutritional status was associated with higher mortality and lower extubation rates. Mild hypertriglyceridemia and some gastrointestinal intolerance were significant in group A, with no impact on the adequacy of energy or protein delivery.
CONCLUSION
The high-fat enteral feeding protocol may contribute to reducing carbon dioxide tension, with mild hypertriglyceridemia and negligible gastrointestinal intolerance as potential adverse effects. Optimization of nutritional status rather than dietary modification may improve ventilatory and survival outcomes in critically ill-ventilated children.

Keyword

Enteral nutrition; High fat diet; Critical illness; Pulmonary disease; Malnutrition

MeSH Terms

Carbon Dioxide
Child*
Critical Care
Critical Illness*
Diet
Diet, High-Fat
Energy Intake
Enteral Nutrition
Food Habits*
Humans
Hypertriglyceridemia
Intensive Care Units
Lung Diseases
Malnutrition
Mortality
Nutrition Assessment
Nutritional Status*
Ventilation
Ventilators, Mechanical
Carbon Dioxide