ENTERAL NUTRITION IN ARTIFICIALLY VENTILA TED PATIENTS WITH CHRONIC OBSTRUCTIVE LUNG-DISEASE - INFLUENCE OF CONVENTIONAL FEEDING ON ANTHROPOMETRIC AND BIOCHEMICAL PARAMETERS

The influence of conventional gastric tube feeding on anthropometric a nd biochemical parameters was studied prospectively during 12 months i n 14 patients with chronic obstructive lung disease put on mechanical ventilation for respiratory failure. The anthropometric parameters wer e: body weight, tricipital skin fold, brachial and brachial muscle cir cumferences. The biochemical parameters included albumin, transferrin, retinol binding protein, transthyretin, acid alpha-1-glycoprotein, C- reactive protein, fibronectin and aminoacids in blood, and 3-methylhis tidine in urine. Measurements were performed on inclusion, then every 3 days until D15. After 15 days of a nutrition bringing 28.8 +/- 8.9 c alories/kg/day and 13.9 +/- 2.2 grams of nitrogen per day, no improvem ent in anthropometric parameters was observed. On DO, comparisons with healthy controls showed that visceral serum proteins levels were sign ificantly lower and inflammatory proteins levels significantly higher (P < 0.05); the levels of protein metabolism markers were higher, but not significantly, and those of the principal glucose-forming aminoaci ds were significantly lower (P < 0.01). On D15, comparisons with the i nitial values showed that the values of retinol binding protein and tr ansthyretin were increased (P < 0.05 and 0.01 respectively), whereas t he values of the other visceral proteins were little modified; yet the ir concentrations remained significantly lower than those found in con trols, except for the retinol binding protein. Inflammatory proteins l evels were high, with a significant (P = 0.05) difference for the acid alpha-1-glycoprotein, and the patients remained in slight catabolism while their nitrogen balance was positive. These results should encour age to carry out studies on the qualitative composition of artificial nutrition in order to optimize its effectiveness in the treatment of t hese patients.