Nutrition des patients en insuffisance respiratoire aiguë

Abstract

The nutritional guidelines in patients suffering from acute respiratory insufficiency are close to these recommended in the critically ill patients. But in acute respiratory failure, the constancy of an oxygen debt and the frequent high carbon dioxide levels, are particular elements to consider at the time of the choice of the nutrition support. Lipid emulsions used in parenteral nutrition have been associated with different pulmonary function changes. In general, caloric intakes should not exceed the total energy expenditure because of the risk of hypercapnia, mainly in patients with reduced ventilatory capacities, carbohydrates ensuring 65 to 70% of the energy. Parenteral fat emulsions, in particular those containing soybean oil, may induce pulmonary gas exchange disturbances in patients with underlying abnormalities of the ventilation-perfusion ratio, but only with fast infusion rates or if the amounts of linoleic acid are too high. Some pharmaconutrients, in particular glutamine, n-3 serie long chains polyunsaturated fatty acids (DHA and EPA), gamma-linoleic acid and trace elements, represent important ways of progress in the population of ARDS patients. By modulating pulmonary inflammation, immunity, bronchial reactivity and by improving the nutritional status, they open new and promising prospects in the prevention and the treatment of ARDS, whose prognosis remains poor.