Impact of high fat low carbohydrate enteral feeding on weaning from mechanical ventilation

Faramawy, Mohammad A.E.; Allah, A. Abd; Batrawy, Sherouk El; Amer, Halima

doi:10.1016/j.ejcdt.2014.07.004

Cited by 18 publications

(23 citation statements)

References 16 publications

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“…As admission progresses, patient acuity improves and tolerance of nutrition provision is better thereby increasing the amount of carbohydrate tolerated. Secondly, an alternative explanation relates to studies which have shown an association between carbohydrate and hypercapnea in patients with respiratory issues (27,28,39). This provides clinical cause for our finding pertaining to increased duration of ventilation.…”

Section: Nutrition Related Variables and Clinical Outcomesmentioning

confidence: 92%

“…A reduction in glycaemic load by using a diabetes specific formula is associated with a reduction in the requirement for exogenous insulin and an improvement in glycaemic variability (24)(25)(26). In addition to this, low carbohydrate formulae were also historically used to assist with management of hypercapnea (27,28). These applications though do not form part of the international nutrition care guidelines for critically ill patients and hence are M A N U S C R I P T…”

Section: Introductionmentioning

confidence: 99%

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Glycaemic variability and its association with enteral and parenteral nutrition in critically ill ventilated patients

et al. 2019

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This study confirms that GV was associated with excess mortality. Furthermore, administration of increasing doses of insulin was associated with increased GV. Increased carbohydrate intake was associated with an increased insulin requirement, as well as increased duration of mechanical ventilation and ICU length of stay. These findings provide important context for further prospective trials investigating the effect of carbohydrate provision in mechanically ventilated critically ill patients requiring artificial nutritional support.

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Section: Nutrition Related Variables and Clinical Outcomesmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Glycaemic variability and its association with enteral and parenteral nutrition in critically ill ventilated patients

et al. 2019

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“…High-fat, low-carbohydrate enteral feeding of patients with type II respiratory failure (the inability to expel CO 2 at a normal rate) reduced the mean length of time on a ventilator by 40%, from 158 hours down to 96 hours, compared to patients on high-carbohydrate, low-fat enteral feeding [ 110 ]. Arterial blood CO 2 levels, an indicator of patient respiratory distress, decreased to 18% for patients in the high-fat group at the time of weaning off the ventilator.…”

Section: High-fat Diet Decreases the Average Time On A Ventilator mentioning

confidence: 99%

COVID-19: Proposing a Ketone-Based Metabolic Therapy as a Treatment to Blunt the Cytokine Storm

Bradshaw

Seeds²,

Miller

et al. 2020

Oxidative Medicine and Cellular Longevity

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Human SARS-CoV-2 infection is characterized by a high mortality rate due to some patients developing a large innate immune response associated with a cytokine storm and acute respiratory distress syndrome (ARDS). This is characterized at the molecular level by decreased energy metabolism, altered redox state, oxidative damage, and cell death. Therapies that increase levels of (R)-beta-hydroxybutyrate (R-BHB), such as the ketogenic diet or consuming exogenous ketones, should restore altered energy metabolism and redox state. R-BHB activates anti-inflammatory GPR109A signaling and inhibits the NLRP3 inflammasome and histone deacetylases, while a ketogenic diet has been shown to protect mice from influenza virus infection through a protective γδ T cell response and by increasing electron transport chain gene expression to restore energy metabolism. During a virus-induced cytokine storm, metabolic flexibility is compromised due to increased levels of reactive oxygen species (ROS) and reactive nitrogen species (RNS) that damage, downregulate, or inactivate many enzymes of central metabolism including the pyruvate dehydrogenase complex (PDC). This leads to an energy and redox crisis that decreases B and T cell proliferation and results in increased cytokine production and cell death. It is hypothesized that a moderately high-fat diet together with exogenous ketone supplementation at the first signs of respiratory distress will increase mitochondrial metabolism by bypassing the block at PDC. R-BHB-mediated restoration of nucleotide coenzyme ratios and redox state should decrease ROS and RNS to blunt the innate immune response and the associated cytokine storm, allowing the proliferation of cells responsible for adaptive immunity. Limitations of the proposed therapy include the following: it is unknown if human immune and lung cell functions are enhanced by ketosis, the risk of ketoacidosis must be assessed prior to initiating treatment, and permissive dietary fat and carbohydrate levels for exogenous ketones to boost immune function are not yet established. The third limitation could be addressed by studies with influenza-infected mice. A clinical study is warranted where COVID-19 patients consume a permissive diet combined with ketone ester to raise blood ketone levels to 1 to 2 mM with measured outcomes of symptom severity, length of infection, and case fatality rate.

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“…A high-fat, low-carbohydrate diet is also beneficial for patients with respiratory failure or ARDS. Studies found that a high-fat, low-carbohydrate diet shortened the duration of ventilator use in patients with respiratory failure and ARDS ( 95 , 96 ). Therefore, an EKD together with moderate high-fat supplementation may blunt the COVID-19-induced cytokine storm.…”

Section: Nonpharmacological Interventionsmentioning

confidence: 99%

The Centrality of Obesity in the Course of Severe COVID-19

et al. 2021

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The ongoing coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global public health challenge. Most patients do not experience severe complications, but approximately 25% of patients progress to acute respiratory distress syndrome (ARDS), and the mortality rate is approximately 5–7%. Clinical findings have determined several risk factors for severe complications and mortality in COVID-19 patients, such as advanced age, smoking, obesity, and chronic diseases. Obesity is a common and serious health problem worldwide that initiates a cascade of disorders, including hypertension, cardiovascular disease (CVD), diabetes mellitus, and chronic kidney disease (CKD). The presence of these disorders is linked to a more severe course of COVID-19. Given the “epidemic” of obesity worldwide and the importance of obesity in the progression of COVID-19, we investigated the mechanisms through which obesity increases the susceptibility to and severity of COVID-19 to support the selection of more appropriate therapies for individuals with obesity.

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Impact of high fat low carbohydrate enteral feeding on weaning from mechanical ventilation

Cited by 18 publications

References 16 publications

Glycaemic variability and its association with enteral and parenteral nutrition in critically ill ventilated patients

Glycaemic variability and its association with enteral and parenteral nutrition in critically ill ventilated patients

COVID-19: Proposing a Ketone-Based Metabolic Therapy as a Treatment to Blunt the Cytokine Storm

The Centrality of Obesity in the Course of Severe COVID-19

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