Nutrition for the respiratory insufficient patient.

Malnutrition is fairly common in patients with chronic obstructive pulmonary disease, the more severe the airway obstruction the more severe the nutritional status. The consequences of nutritional depletion on respiratory and immune systems are ventilatory compromise and susceptibility to infection. Diaphragm muscle mass and thickness is decreased in patients with COPD. This results in decreased maximum voluntary ventilation and diminished inspiratory pressure. Malnutrition is one of the causes of failure to wean in patients with respiratory failure. Malnutrition also has profound effects on cell-mediated immune response and humoral immunity with reduced levels of secretory IgA. In patients with COPD, colonization of respiratory tract bears a direct relationship with parameters of nutritional status. Patients with significant nutritional impairment have more tracheal cell bacteria adhered to and the tracheas were more frequently colonized by Pseudomonas species. The improvement of nutrition in these patients resulted in less bacterial cell binding to tracheal epithelial cells.