Improving ARDS Patient Outcomes with Metabolic Support


Name: Mary McCarthy

Rank: MAJ (ret), USA

Organization: The Geneva Foundation

Performance Site: Madigan Army Medical Center, Tacoma, WA

Year Published: 1998

Abstract Status: Final


This prospective, randomized, experimental study evaluated immunonutrition effects on nutritional and physiological responses in ICU patients with acute lung injury (ALI) or adult respiratory distress syndrome (ARDS). Subjects received a "house" stress formula (Ultracal) or Oxepa, the immune-modulated formula for ALI/ARDS. Variables were albumin, pre-albumin, feeding volume, percentage of caloric goal achieved, GI complications, energy expenditure, and inflammatory status. Demographic and baseline study variables were compared using t tests and chi-square tests. Nutritional and physiological variables (nutritional intake, cytokine profiles, and ventilation) were analyzed using one-way ANOVA, repeated measures ANOVA, chi-square, Fischer's exact test, and Wilcoxon's rank sum test. Kaplan-Meier survival analysis was used to compare patient outcomes.The study accrued 19 ALI/ARDS patients, most 60 years of age, Caucasian, female, and admitted for pneumonia, with no differences in APACHE II scores (mean = 20.8), lung injury scores (mean = 2.75), PaO2/FiO2 ratios (mean day 1 = 136), or baseline nutritional status. IL-l╬▓, IL-6, and TNF-╬▒ did not predict mortality and were elevated on day 1 and trended toward normal on day 4 in both groups. Days on mechanical ventilation, days to weaning, and mortality were similar in both groups. The control group trended toward more days on ventilator support, less success weaning, and worse oxygenation variables. No difference was found in ICU length of stay, hospital length of stay, or hospital disposition. Mortality was 47%. Survivors improved in major oxygenation variables, cytokine-mediated inflammatory status, and volume of feeding over the 7 days.No differences were found in physiologic or nutritional outcomes between those who received an immune-modulated enteral formula and those on a standard hospital formula. The findings show that critically ill patients can be fed successfully, early in the course of the disease, and with few gastrointestinal complications.


Final report is available on NTRL: