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COPD and NUTRITIONAL SUPPORT

COPD and NUTRITIONAL SUPPORT. Sait Karakurt, Assoc. Prof. Marmara University Medical School Pulmonary and Critical Care Medicine. COPD- PULMONARY CACHEXIA definition, prevalence. defined as <90 percent ideal body weight) the prevalence 30-70 %.

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COPD and NUTRITIONAL SUPPORT

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  1. COPD and NUTRITIONAL SUPPORT Sait Karakurt, Assoc. Prof. Marmara University Medical School Pulmonary and Critical Care Medicine

  2. COPD- PULMONARY CACHEXIAdefinition, prevalence • defined as <90 percent ideal body weight) • the prevalence 30-70 %. • More common in patients required mechanical ventilation

  3. COPD-malnutrition and mortality Chailleux, E, Laaban, J-P, Veale, D. Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy. Chest 2003; 123:1463

  4. COPD- PULMONARY CACHEXIAContributing factors • Metabolism and caloric intake • Aging • Exercise  • Hypoxia • Inflammation (TNF alfa, IL6) • Medications

  5. COPD-malnutrition-muscle Kelsen, SG, Ference, M, Dapoor, S, J Appl Phsiol 1985; 58:1354.

  6. COPD-muscle strength -CO2 • Carbon dioxide retention begins when respiratory muscle strength is <50 percent of normal and becomes marked when respiratory muscle strength is <25 to 35 percent of normal in individuals without lung disease

  7. Malnutrition- deleterious effects • Wound healing • Intestinal mucosal atrophy • Decrease in muscle mass • Diminished immune competence • Development of edema

  8. Anabolic metabolism in muscle

  9. METABOLIC RESPONSE in CRITICAL PATIENT Jeevanandan M et al. JPEN 1992;16:511-520

  10. COPD-Treatment • Optimization of lung function • Regular exercise, which has been shown to improve the effectiveness of nutritional therapy and to stimulate appetite • Improvement of oxygen delivery through oxygen therapy, correction of anemia, and/or optimization of cardiac function • Control of inflammation as much as possible, while limiting oral corticosteroid use

  11. COPD-Nutritional therapy  • Adequate calories to meet their basal energy expenditure • Small, frequent meals with nutrient-dense foods (eg, eggs) • Meals requiring little preparation (eg, microwaveable) • Rest before meals • Daily multivitamin

  12. ENERGY SOURCES • Main source is lipids. • Protein is not stored. • Carbohydrates are stored in liver as glycogen and 1 day requirement is probable.

  13. ASSESSMENT of NUTRITIONAL STATUS • History • Weight loss 10% in last 6 months, 5% in last month • Physical examination • Inspection • Antropometric measurements • Muscle strenght • Lab • Serum albumin, prealbumin, transferrin, retinol binding protein • Lymphocyte count • Nitrogene balance

  14. Basal Energy RequirementsHarris-Benedict formula(kcal/day) Men • 66+(13.7xW)+(5xH)-(6.8xA) Woman • 665+(9.6xW)+(1.8xH)-(4.7xA) • Body weight (kg) • H=height (cm) • A=age(year)

  15. Basal Energy Requirements BMI -BMI(kg/m2) Energy requirement (kcal/kg/day) <15 35-40 15-19 30-35 20-29 20-25 >30 15-20 900 kcal/m2/day (man), 850 kcal/m2/gün (woman) 25-35 kcal/kg

  16. Measurement of total calori • For maintenence 1.5xBEE • For anabolic effect 1.8xBEE

  17. COPD-nutritional support • High carbohydrate intake may result in CO2 retension in respiratory failure • R/Q (CO2 production/O2 delivery) • R/Q=1 (carbohydrate) • R/Q=0.8 (protein) • R/Q=0.7 (fat) • R/Q>1 (shows execcive carbohydrate intake)

  18. COPD-calori intake -CO2 production Talpers, S, Romberger, D, Bunce, S, et al, Chest 1992; 102:551

  19. COPD-nutritional support • Fat/carbohydrate 3/1 • Fat ratio should be 15-40% of total calori • Megestrol asetat, 800mg/day • Oxandrolon 10 mg, bid • Glutamin, arginin, omega 3 are not routine (Level IIB)

  20. COPD-nutritional support • Patients with advanced lung disease should receive a caloric intake that matches estimated energy expenditure, in order to avoid excess CO2 production, (1.5xBEE). • Mixed carbohydrate-fat diets in which fat comprises 20 to 40 percent of the total calories should be used preferentially • The use of very high fat (>40 percent) or very low fat (<15 percent) diets is not recommended; the former is poorly tolerated and can result in diarrhea and abdominal discomfort, while the latter increases CO2 production and does not deliver enough essential fatty acids.

  21. BESLENME DESTEĞİNİN MONİTÖRİZASYONU 1-Elektrolit, asit-baz -kan gazları endike oldukça -Na,Cl,K,HCO3 qdx3, qw -Mg,Ca,PO4 2 haftada bir -İdrar elektrolit endike oldukça 2-Glukoz toleransı -glukoz günlük -idrar glukoz,keton 6 saatte bir 3-Yağ toleransı -makroskopik lipemi her kan alınışta -trigliserid haftada bir 4-Sıvı dengesi -BUN,kreatinin 2 haftada bir -Vücut ağılığı günlük -Hematokrit 2 haftada bir -Vital bulgular 6 saatte bir -Aldığı çıkardığı sıvı günlük 5-Böbrek ve karaciğer -BUN, kreatinin 2 haftada bir Fonksiyonları -AST,AF,bilirübin 2 haftada bir

  22. BESLENME DESTEĞİNİN MONİTÖRİZASYONU 6-Beslenme durumu kalori-protein alımı günlük vücut ağırlığı günlük azot dengesi haftada bir serum albümin haftada bir serum esansiyel yağ asiti endike oldukça serum eser elementleri endike oldukça serum transferrin haftada bir serum vitamin endike oldukça

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