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

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.

Prognostic value of cardiac troponin I and left ventricular geometry in pediatric chronic hemodialysis: a one year follow up study

Increase in left ventricular mass index [LVMI] is associated with an increase in the incident risk of fatal and nonfatal cardiovascular events in chronic renal failure [CRF]. Cardiac troponin I [cTnl] has been shown to be specific for myocardial damage in chronic dialysis patients. To assess LVMI and cTnI in pediatric patients with CRF on chronic hemodialysis [HD] and to determine their relation to dialytic hypotensive episodes as well as mortality over a period of one year. A prospective follow up study was conducted on 30 pediatric patients with CRF on chronic regular HD with a mean age [10.3 +/- 3.04 years]. Cases were subjected to clinical evaluation, 2-D, M-mode, pulsed and color Doppler echocardiography. Calculation of left ventricular mass [LVM] and LVMI were done. Assessment of cTnI using one-step serum immunoassay test was performed. Cases were clinically followed up for 1 year for dialytic hypotensive episodes and mortality. LVMI was increased in 20 cases [66.7%]. Concentric hypertrophy was present in 13 patients and eccentric hypertrophy was detected in 7 patients. Another six cases had concentric remodeling. All cases were negative for cTnl. There was a statistically significant difference between CRF patients with LVH and those with normal LVM as regards pH, HCO3 and left ventricular posterior wall thickness [LVPW] [p<0.05]. A positive correlation markedly approaching significance was found between fractional shortening [FS] and body mass index [BMI] [r=0.35. p=0.05]. Mortality was 10% and hypotensive episodes occurred in 13.3% of the cases. The positive predictive value of LVMI to mortality was 28.6%, negative predictive value 95.7% with 81.5% specificity and 66.7 +/- sensitivity. Low FS was an excellent predictor of mortality in the studied cases with positive predictive value 100 +/- , and negative predictive value 96.4% with 100% specificity and 66.7% sensitivity. Normal cardiac Troponin I does not preclude cardiovascular risk in chronic hemodialysis patients. Increased LVMI and low FS are useful predictors of mortality in chronic pediatric hemodialysis patients