Respiratory System

KNH 406

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

120-130 kcal/kg/day or higher

Protein 3-4 g/kg/day

Vitamins and minerals

Vitamin A 1500-2800 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 CO2 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