AKUT AKCİĞER HASARI (ALI)/AKUT SOLUNUM SIKINTISI SENDROMU(ARDS) VE ARDS’Lİ COVID-19 HASTALARINDA BESLENME DESTEĞİ

Abstract

Amerika- Avrupa Konsensus Konferans Komitesi tanımına göre “akut solunum sıkıntısı sendromu”(ARDS) göğüs radyolojisinde akut başlangıçlı yaygın bilateral pulmoner infiltratlar, arteriyel oksijen/fraksiyon parsiyel basıncı (PaO2/FiO2) “akut akciğer hasarı”(ALI) için ≤300 mmHg ve ARDS için ≤200 mmHg ve pulmoner arter oklüzyon basıncı <18 mmHg olması durumudur. Epidemiyolojik çalışmalara göre her yıl ALI/ARDS insidansı 100,000’de 30- 75 vaka arasında değişmektedir. Tedaviye cevap vermeyen respiratuar yetmezlik, çoklu organ yetmezliği ve bazı durumlarda ölümle sonuçlanabilmektedir. Son yıllarda yapılan çalışmalar ALI/ARDS’nin mortalite oranını 30-45% olarak göstermektedir. ALI/ARDS’nin patofizyolojisi pro-inlamatuar yanıt ile karakterizedir. ALI/ARDS’de karakterize olan pro- inflamatuar yanıt ve buna bağlı hiperkatabolizma önemli beslenme yetersizliklerine neden olabilir. Beslenme desteği; artan enerji ihtiyacının karşılanması, malnütrisyonun, yağsız vücut kütlesi kaybının, respiratuar kas gücü azalmasının önüne geçmek için ARDS’li hastalarda oldukça önemlidir. ARDS’li hastalarda beslenme desteği için enerji gereksinmesinin doğru hesaplanması hiperkapni, enfeksiyonlar, zayıf yara iyileşmesi, hiperglisemi, yoğun bakımda kalma süresinin artması gibi önemli klinik komplikasyonların oluşmasını engellemek ve hastalığın seyrini olumlu yöne çevirmek için oldukça önemlidir. Bu gereksinmelerin belirlenmesinde konsensus kılavuzları yol gösterici olmaktadır. ARDS’li hastalarda beslenme desteğinin olumlu etkilerinden maksimum yararlanmak için oral beslenmenin olmadığı veya yetersiz olduğu durumlarda erken enteral beslenmenin uygulanması, enteral beslenmenin mümkün olmadığı ya da yetersiz olduğu durumlarda tek başına parenteral beslenme veya enteral beslenme ile beraber parenteral beslenme yöntemlerinin tercih edilmesi gereklidir. ARDS’li hastalarda inflamasyonu önlemeye yönelik olarak; omega-3 yağ asitleri ve antioksidanlar ile zenginleştirilmiş ürünlerin kullanımının hastalığın klinik sonuçlarında olumlu etkiler yaratacağına dair bilgiler bulunmakla beraber, halen tartışma konusudur.

Keywords

• ARDS
• ALI
• malnütrisyon
• beslenme desteği
• enteral beslenme
• COVID-19

NUTRITIONAL SUPPORT FOR ACUTE LUNG INJURY (ALI)/ACUTE RESPIRATORY SYNDROME (ARDS) AND COVID-19 PATIENTS WITH ARDS

Abstract

According to the definition of American- European Consensus Conference Committee ARDS requires the acute onset of diffuse bilateral pulmonary infiltrates by chest radiograph; a partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ≤300 mmHg for ALI and ≤200 mmHg for ARDS; and a pulmonary artery wedge pressure <18 mm Hg. Epidemiology studies that have used this definition have reported that the incidence of ALI/ARDS is between 30 and 75 cases per 100,000 each year. The respiratory failure with resistant to treatment may result multiple organ failure and death. Recent studies indicate the mortality rate of ALI/ARDS, 30–45%. Pathophysiology of ALI/ARDS characterized by pro-inflammatory response. Pro-inflammatory response and hypercatabolism may be cause important nutrition deficiencies. Nutrition support is essential to avoid energy deficiency, malnutrition, loss of lean body mass, decrease of respiratory muscle strength. The correct calculation of energy requirement in patient with ARDS is very important for preventing important clinical complications like hypercapnia, infections, poor wound healing, hyperglycemia, increased stay in intensive care unit. Determination of this requirements, the consensus guidelines are used. In patients with ARDS; if the oral nutrition is impossible or inadequate, the early enteral feeding; and if the enteral nutrition is impossible or inadequate, the parenteral feeding or enteral combined parenteral feeding should be preferred in order to maximize the benefits of nutritional support. While there is some information about using the supplements enriched with omega- 3 fatty acids and antioxidants are beneficial to prevent the inflammation in patients with ARDS, this subject is still discussed.

Keywords

• ARDS
• ALI
• malnutrution
• nutritional support
• enteral nutrition
• COVID-19

References

1. 1- Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet, 1967, 2, 319- 323.
2. 2- Bernard GR, Artigas A, Brigham KL, et al. The American- European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994, 149(1), 818- 824.
3. 3- Goss CH, Brower RG, Hudson LD, Rubenfeld GD; ARDS Network. Incidence of acute long injury in the United States. Crit Care Med. 2003, 31, 1607- 1611.
4. 4- Wheeler AP, Bernard GR. Acute lung injury and the acute respiratory distress syndrome: a clinical review. Lancet. 2007, 369(9572), 1553- 1564.
5. 5- Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome . The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000, 342, 1301- 1308.
6. 6- Milberg JA, Davis DR, Steinberg KP, Hudson LD. Improved survival of patients with acute respiratory distress syndrome (ARDS): 1983-1993. JAMA. 1995,273,306-309.
7. 7- McIntyre RCJr, Pulido EJ, Bensard DD, Shames BD, Abraham E. Thirty years of clinical trials in acute respiratory distress syndrome. Crit Care Med. 2000, 28, 3314-3331.
8. 8- Pratt PC, Vollmer RT, Shelburne JD, Crapo JD. Pulmonary morphology in a multihospital collaborative extracorporeal membrane oxygenation project. I. Light microscopy. Am J Pathol. 1979, 95, 191-214.

9. 9- Cerra FB, Benitez MR, Blackburn GL, ve ark. Applied nutrition in ICU patients. A consensus statement of the American College of Chest Physicians. Chest Journal. 1997,111, 769-778.
10. 10- McClave SA, Martindale RG, Vanek VW, ve ark. A.S.P.E.N. Board of Directors, Americal College of Critical Care Medicine, Society of Critical Care Medicine. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N). JPEN Parenter Enteral Nutr, 2009, 33(3), 277- 316.
11. 11- Fraser IM. Effects of refeeding on respiration and skeletal muscle function. Clin Chest Med 1986, 7,131- 9.
12. 12- Fraser IM. Effects of refeeding on respiration and skeletal muscle function. Clin Chest Med 1986, 7, 131- 139.
13. 13- Heyland DK, Dhaliwal R, Drover JW, et al. Canadian Critical Care Clinical Practice Guidelines Commitee. Canadian clinical practice guidelines for nutrition support support in mechanically ventilated, ciritically ill adulp patients. JPEN J Parenter Enteral Nutr 2003, 27(5), 355- 373. Update January 2009. Available at: http://www.criticalcarenutrition.com/docs/cpg/srrev.pdf Erişim; Mayıs 23,2016
14. 14- Marik PE, Zaloga GP. Early enteral nutiriton in acutelly ill patients: a systematic review. Crit Care Med 2001, 29, 2264- 2270.
15. 15- Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr. 2003, 27, 355-373.
16. 16- Peter JV, Moran JL, Phillips-Hughes J. A metaanalysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients. Crit Care Med. 2005, 33, 213-220; discussion 260-261.
17. 17- Villet S, Chiolero RL, Bollmann MD, ve ark. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr. 2005, 24, 502-509.
18. 18- Simpson F, Doig GS. Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle. Intensive Care Med. 2005, 31, 12-23.
19. 19- Heidegger C, Darmon P, Pichard C. Enteral vs. parenteral nutrition for the critically ill patient: a combined support should be preferred. Curr Opin Crit Care. 2008, 14, 408-414.
20. 20- Kreymann KG, Berger MM, Deutz NEP, et al. ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr. 2006, 25, 210-223.
21. 21- Bauer P, Charpentier C, Bouchet C, Nace L, Raffy F, Gaconnet N. Parenteral with enteral nutrition in the critically ill. Intensive Care Med. 2000, 26, 893-900.
22. 22- Wooley JA, Sax HC. Indirect calorimetry: applications to practice. Nutr Clin Pract 2003;18(5):434- 439.
23. 23- Walker RN, Heuberger RA. Predictive equations for energy needs for the critically ill. Respir Care. 2009, 54 509-521.
24. 24- Anna K, Melissa P, Lena MN. Nutrition Therapy for ALI and ARDS. Crit Care Clin 2011, 27, 647–659.
25. 25- Alexander E, Susla GM, Burstein AH, Brown DT, Ognibene FP. Retrospective evaluation of commonly used equations to predict energy expenditure in mechanically ventilated, critically ill patients. Pharmacotherapy. 2004, 24, 1659-1667.
26. 26- O’Brien JM, Welsh CH, Fish RH, Ancukiewicz M, Kramer AM; National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network. Excess body weight is not independently associated with outcome in mechanically ventilated patients with acute lung injury. Ann Intern Med. 2004, 140, 338-345.
27. 27- Heyland DK, Dhaliwal R, Drover JW, et al. Canadian Critical Care Clinical Practice Guidelines Commitee. Canadian clinical practice guidelines for nutrition support support in mechanically ventilated, ciritically ill adulp patients. JPEN J Parenter Enteral Nutr 2003, 27(5), 355- 373. Update January 2009. Available at: http://www.criticalcarenutrition.com/docs/cpg/srrev.pdf Erişim; 01 Ağustos, 2021
28. 28- Kreymann KG, Berger MM, Deutz NEP, ve ark. ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr. 2006, 25, 210-223.
29. 29- Krista LT, Frederick AM, Robert M. Nutrition Support for the Acute Lung Injury/Adult Respiratory Distress Syndrome Patient: A Reviw, Nutr Clin Prac 2011, 26, 14-25.
30. 30- Lo H, Lin C, Tsai L. Effects of hypercaloric feeding on nutrition status and carbon dioxide production in patients with long-term mechanical ventilation. JPEN J Parenter Enteral Nutr. 2005, 29, 380-387.
31. 31- Liposky JM, Nelson LD. Ventilatory response to high caloric loads in critically ill patients. Crit Care Med. 1994, 22, 796-802.
32. 32- Benotti PN, Bistrian B. Metabolic and nutritional aspects of weaning from mechanical ventilation. Crit Care Med. 1989, 17, 181-185.
33. 33- Jannace PW, Lerman RH, Dennis RC, Aalyson M, Yeston NS. Total parenteral nutrition-induced cyclic hypercapnia. Crit Care Med. 1988, 16, 727-728.
34. 34- Talper SS, Romberger DJ, Bunce SB, et al. Nutritionally associated increased carbon dioxide production. Excess total calories vs high proportion of carbohydrate calories. Chest, 1992, 102, 551- 555.
35. 35- Al-Saady NM, Blackmore CM, Bennett ED. High fat, low carbonhydrate, enteral feeding lowers PaCO2 and reduces the period of ventilation in artificially ventilated patients. Intensive Care Med 1989, 15, 290- 295.
36. 36- Barale F, Verd S, Boillot A, ve ark. Calorimetric study of enteral low- carbohydrate diet in patients with respiratory insufficiency and decompensation. Agressologie 1990, 31, 77- 79.
37. 37- O’Brien JM, Welsh CH, Fish RH, Ancukiewicz M, Kramer AM; National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network. Excess body weight is not independently associated with outcome in mechanically ventilated patients with acute lung injury. Ann Intern Med. 2004, 140, 338-345.
38. 38- Akinnusi ME, Pineda LA, El Solh AA. Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med. 2008, 36, 151-158.
39. 39- Dickerson RN. Hypocaloric feeding of obese patients in the intensive care unit. Curr Opin Clin Nutr Metab Care. 2005, 8, 189-196.
40. 40- Frankenfield DC, Rowe WA, Smith JS, Cooney RN. Validation of several established equations for resting metabolic rate in obese and nonobese people. J Am Diet Assoc. 2003, 103, 1152-1159.
41. 41- McClave SA, Martindale RG, Vanek VW, ve ark. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2009, 33, 277-316.
42. 42- Pontes-Arruda A,Demichele S, Seth A, ve ark. The use of an inflammation- modulating diet in patients with acute lung injury or acute respiratory distress sydrome: a meta- analysis of outcome data. JPEN J Parenter Enteral Nutr, 2008,32,596.
43. 43- Nelson JL, DeMichele SJ, Pacht E, ve ark. Enteral Nutrition in ARDS Study Group. Effect of enteral feeding with eicosapentaenoic acid, gamma- linoleic acid, and antioxidants on antioxidan status in patients with acute respiratory distress syndrome. JPEN J Parenter Enteral Nutr 2003, 27, 98- 104.
44. 44- McClave SA. The consequences of overfeeding and underfeeding. J Respir Care Pract 1997, 10, 57- 64.
45. 45- Gadek JE, DeMichele SJ, Karlstad MD, ve ark. Effect of enteral feeding with eicosapentaenoic acid, gamma- linoleic acid, and antioxidants in patients with acute respiratory distress syndrome. Crit Care Med 1999, 27, 1409- 1420.
46. 46- Pontes-Arruda A, Aragao AM, Albuquerque JD. Effects of enteral feeding with eicosapentaenoic acid, gamma- linoleic acid, and antioxidants in mechanically ventilated patients with severe sepsis and septic shock. Crit Care Med 2006, 34, 2325- 2333.
47. 47- Early versus delayed enteral feeding and omega-3 fatty acid/antioxidant supplementatiton for treating people with acute lung injury or acute respiratory distress syndrome (The EDEN-Omega Study). Available at https://clinicaltrials.gov/ct2/show/NCT00609180 Erişim; 26 Ağustos,2021
48. 48- Joan S, Joan RM, Judit S, Pilar C, Pilar S, Merce P. Effects of an omega-3 fatty acid-enriched lipid emulsion on eicosanoid synthesis in acute respiratory distress syndrome (ARDS): A prospective, randomized, double-blind, parallel group study, Nutrition & Metabolism 2011, 8,22.
49. 49- Mayer K, Grimm H, Grimminger F, Seeger W: Parenteral nutrition with n-3 lipids in sepsis. Br J Nutr 2002, 87(1), 69-75.
50. 50- Grimminger F, Mayer K, Kiss L, Walmrath D, Seeger W: PAF induced synthesis of tetraenoic and pentaenoic leukotrienes in a model of pulmonary microvascular leukostasis. Am Journal of Physiology (lung Cellular and Molecular Physiology) 2000, 278, 268-275.
51. 51- Congcong L, Liyan B, Wei L, Xi L, Faguang J. Enteral Immunomodulatory Diet (Omega-3 Fatty Acid, γ-Linolenic Acid and Antioxidant Supplementation) for Acute Lung Injury and Acute Respiratory Distress Syndrome: An Updated Systematic Review and Meta-Analysis. Nutrients 2015, 7(7), 5572-5585.
52. 52- Nutrition Management of Acute Respiratory Distress Syndrome (ARDS)- COVID-19 in Mechanically Ventilated Patients. Fresenius Kabi Statement https://www.fresenius-kabi.com/gb/documents/Nutrition_Support_in_Acute_Respiratory_Failure_COVID-19.pdf Erişim; 26 Ağustos,2021
53. 53- Wang D, Hu B, Hu C et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China, JAMA Published online 2020, Feb 7.
54. 54- Arentz M, Vim E, Klaff L ve ark. Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. JAMA. Published online March 19, 2020.
55. 55- Barazzoni R, Bischoff SC, Krznaric Z ve ark. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-COV-2 infection. Clinical Nutrition 2020.
56. 56- Peterson SJ, Lateef OB, Freels S et al. Early exposure to recommended calorie delivery in the intensive care unit is associated with increased mortality in patients with acute respiratory distress syndrome. JPEN J Parenter Enteral Nutr. 2018, 42(4), 739-747.
57. 57- Saez de la Fuente I, Saez de la Fuente J, Quintana Estelles MD ve ark. Enteral nutrition in patients receiving mechanical ventilation in a prone position. JPEN.2016, 40, 250-255.
58. 58- Linn DD, Beckett RD, Foellinger K. Administration of enteral nutrition to adult patients in the prone position. Intensive Crit Care Nurs. 2015, 31, 38-43.
59. 59- Sams VG, Lawson CM, Humphrey CL ve ark. Effects of rotational therapy on aspiration risk of enteral feeds. Nutr Clin Pract. 2012, 27(6), 808-11.