This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Iapichino, G. Articles by Gattinoni, L. Search for Related Content PubMed PubMed Citation Articles by Iapichino, G. Articles by Gattinoni, L. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB CARBON DIOXIDE Social Bookmarking                         What's this?

Nutritional Support to Long-Term Anesthetized and Curarized Patients Under Extracorporeal Respiratory Assist for Terminal Pulmonary Failure

Intensive Care Unit "E. Vecla," Ospedale Policlinico, and Istituto Anestesiologia e Rianimazione, Università degli Studi, Milan, Italy

Antonio Pesenti, M.D.

Intensive Care Unit "E. Vecla," Ospedale Policlinico, and Istituto Anestesiologia e Rianimazione, Università degli Studi, Milan, Italy

Danilo Radrizzani, M.D.

Intensive Care Unit "E. Vecla," Ospedale Policlinico, and Istituto Anestesiologia e Rianimazione, Università degli Studi, Milan, Italy

Maurizio Solca, M.D.

Intensive Care Unit "E. Vecla," Ospedale Policlinico, and Istituto Anestesiologia e Rianimazione, Università degli Studi, Milan, Italy

Amerigo Pelizzola, M.D.

Intensive Care Unit "E. Vecla," Ospedale Policlinico, and Istituto Anestesiologia e Rianimazione, Università degli Studi, Milan, Italy

Luciano Gattinoni, M.D.

Intensive Care Unit "E. Vecla," Ospedale Policlinico, and Istituto Anestesiologia e Rianimazione, Università degli Studi, Milan, Italy

Low-frequency positive pressure ventilation with extracorporeal carbon dioxide removal, a new form of respiratory assist, has been applied to 12 patients with terminal respiratory failure, for a cumulative time of 1706 hours (range 27-309). Survival rate was 65% versus an expected 10%. During the procedure, the patients were kept under continuous anesthesia and muscle relaxation.

Nutritional support was provided in all but one patient after an initial fasting lag of 13.4 ± 1.8 (SEM) hours, time devoted to bypass connection and subsequent hemodynamic and respiratory equilibration (9% of the total time on bypass).

Three patients received only parenteral nutrition, two underwent, from the beginning, mixed, parenteral, and enteral nutrition, whereas the other six patients switched from parenteral to mixed treatment during the extracorporeal procedure.

Under parenteral nutrition we were careful to refrain from excessive calorie administration and in water intake restriction.

Enteral nutrition was administered for an overall time of 860 hours in eight patients, ie, for 62% of the bypass duration, and provided about two-thirds of the energy and protein intake. It had to be interrupted in four cases for: intolerance to the diet, gastric hypotone due to polyradiculoneuritis, and two episodes of gastric bleeding in septic shock.

In our opinion, effective nutritional support can be provided safely to patients acutely and severely ill, undergoing highly invasive and long-term procedures such as extracorporeal respiratory assist. Moreover, enteral nutrition is generally possible, and well-tolerated, even if the patients are kept continuously anesthetized and curarized.

Journal of Parenteral and Enteral Nutrition, Vol. 7, No. 1, 50-54 (1983)
DOI: 10.1177/014860718300700150


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				L. Gattinoni, A. Pesenti, D. Mascheroni, R. Marcolin, R. Fumagalli, F. Rossi, G. lapichino, G. Romagnoli, L. Uziel, A. Agostoni, et al. Low-Frequency Positive-Pressure Ventilation With Extracorporeal CO2 Removal in Severe Acute Respiratory Failure JAMA, August 15, 1986; 256(7): 881 - 886. [Abstract] [PDF]