Respiratory System KNH 411

Respiratory System Nutritional status and pulmonary function are interdependent Macronutrients fueled using oxygen and carbon dioxide Malnutrition can evolve from pulmonary disorders And can contribute to declining pulmonary status

Nutrition and Pulmonary Health Protein-energy malnutrition Antioxidants and lung function Cigarette smokers Early satiety, anorexia, weight loss, cough, dyspnea during eating

Bronchopulmonary Dysplasia (BPD) Growth failure d/t decreased nutrient intake, increased requirements, hypoxemia, delayed skeletal mineralization and osteopenia

Bronchopulmonary Dysplasia (BPD) Treatment/Nutrition Therapy Energy and macronutrient needs: 15-20% higher kcal/kg/day or higher Protein 3-4 g/kg/day Vitamins and minerals Vitamin A IUs Closely monitor electrolyte balance Sufficient minerals for bone growth

Bronchopulmonary Dysplasia (BPD) Treatment/Nutrition Therapy Mechanical ventilation Nutrition support May need fluid and sodium restriction Specialty infant formulas Breast milk preferred Education and support to caregivers

© 2007 Thomson - Wadsworth

Chronic Obstructive Pulmonary Disease COPD – progressive disease which limits airflow through inflammation of bronchial tubes (bronchitis) Primary risk factor – smoking

COPD Nutrition Therapy Low dietary intake Altered taste perceptions and appetite Elevated REE

COPD Nutrition Therapy - Interventions Maintain optimal energy balance Overfeeding concern with ventilation Glucose >5 mg/kg/min increases CO 2 production Commercial formulas - low CHO (30%) and higher lipid (50%)

COPD Nutrition Therapy - Interventions Supplement antioxidants Monitor serum phosphate Monitor status of calcium and vit. D Identify specific nutrition problems Manage weight

Cystic Fibrosis Nutrition Poor digestion, absorption, malnutrition d/t pancreatic insufficiency Abnormal growth Risk for osteopenia and osteoporosis

Cystic Fibrosis Nutrition Assessment National CF Foundation consensus guidelines - nutrition guidelines Special attention to poor growth: Use growth charts – CDC Timeline

Cystic Fibrosis Pancreatic enzyme therapy Given with food and beverages Individualized Adequate kcal for normal growth based on weight gain patterns Higher fat intake (35-45% kcal) MCT Glucose intolerance common

Cystic Fibrosis Monitor vitamin & mineral status Monitor sodium levels Assess iron and zinc status Recommend breast feeding Developmentally appropriate recommendations Formulas or nutritional supplements

Respiratory Failure Nutrition Meet nutrition needs Energy needs vary widely; may be hypermetabolic Avoid overfeeding Indirect calorimetry preferred method Preserve and restore LBM; respiratory muscle mass

Respiratory Failure Nutrition Maintain fluid balance Facilitate weaning from ventilation Specialty formulas available EPA and GLA can reduce severity of inflammation Supplementation with antioxidants Phosphate supplementation