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

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.

Ketogenic Diet as a Preventive and Supportive Care for COVID-19 Patients

“…In the literature, there are some evidences of a beneficial effect of a high-fat lowcarbohydrate diet in mechanically ventilated patients [52][53][54], since it was able to reduce PaCO 2 levels [52,53,55] and the time of mechanical ventilation [52,53].…”

“…These may be due to the impaired respiratory mechanics, increased airway resistance and impaired gas exchange [ 25 , 28 , 54 ], as well as obesity-related comorbidities [ 63 ], which appear to be directly related to the onset of complications and severe course of COVID-19. In particular, OSAS [ 38 ], metabolic syndrome, hypertension, Non-Alcoholic Fatty Liver Disease (NAFLD) and diabetes or insulin resistance have all shown to affect COVID-19 outcome negatively [ 55 , 56 , 57 , 58 ]. Finally, it should not be overlooked that obesity is associated with low chronic inflammation within a state of immunological dysfunction that can lead to increased risk of allergies [ 64 ] or ineffective response against infections [ 35 ] and vaccines [ 65 ].…”

“…Studies conducted in mice highlighted the beneficial effect of HFD- induced ketone bodies in COVID-19 models [ 10 , 23 ]. In humans, HFKDs has been experimented in Intensive Care Units (ICU) and good results have been reported in mechanically ventilated patients [ 52 , 55 ]. Moreover, telemedicine achieved good results in pediatric epileptic patients under HFKDs, either for safety and compliance, proving that it can be a valid tool to be adopted even in the event of quarantine and fiduciary isolation.…”

The Role of Nutrition in the Prevention and Management of Bronchopulmonary Dysplasia: A Literature Review and Clinical Approach

“…Fat is a good source of nonprotein energy when it is necessary to provide high energy intake in a low volume of feedings [ 93 , 94 ]. For preterm infants with BPD, fat provides essential fatty acids and lipid soluble vitamins, and its oxidation produces less carbon dioxide [ 92 ].…”

Ketogenic Diet for Obese COVID-19 Patients: Is Respiratory Disease a Contraindication? A Narrative Review of the Literature on Ketogenic Diet and Respiratory Function

“…On the other hand, a study on 32 patients requiring mechanical ventilation reported no beneficial effects of a similar low-carbohydrate high-fat enteral nutrition (55.2% fat, 28.1% carbohydrate) in PaCO 2 levels during weaning from the ventilator, respect to a standard enteral nutrition (30% fat, 53.3% carbohydrate) ( 58 ). Another recent study on 51 critically ill ventilated children with pulmonary disease observed that the low-carbohydrate high-fat diet (30% carbohydrate, 50% fat) was effective in reducing carbon dioxide tension but did not reduce the duration or level of ventilatory support ( 59 ).…”