A Practical Approach to the Nutritional Management of Mechanically Ventilated Children: A Review

Abstract

Context: Malnutrition is associated with a longer duration of mechanical ventilation and an increased risk of healthcare-acquired infections in critically ill children who are mechanically ventilated. Objectives: Therefore, nutritional therapy plays a critical role in the initiation and duration of mechanical ventilation and clinical outcomes in such patients. Data Sources: This review was conducted by searching the Web of Science, Scopus, Embase, and Medline databases. A combination of related mesh terms and keywords was used to find the relevant articles. Finally, we screened search results through titles and abstracts and related articles were enrolled in the review process. We tried to address all aspects of nutritional management of mechanically ventilated critically ill children. Results: Energy demand in mechanically ventilated children is a controversial issue and Indirect Calorimetry (IC) is the recommended method to measure resting energy expenditure; however, in the absence of IC, predictive equations may be used. A minimum protein intake of 1.5 g/kg/day and a balanced diet in other macronutrients ratio, including carbohydrates and lipids could be appropriate for mechanically ventilated children. However, the administration of major substrates should be based upon the patient’s metabolism regarding the nature and phase of the illness. Moreover, individualized nutritional supplementation is among the treatment strategies in these children. Conclusions: The optimum individualized nutrition support of mechanically ventilated children is considered a major therapeutic strategy and an essential aspect of their medical management. Further large population-based studies are required to provide appropriate feeding protocols for preventing nutritional inadequacy in such patients.

Keywords

• critically ill children
• mechanically ventilated children
• nutritional management