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Manipulation of macronutrients in the management of pulmonary disease has been a topic of discussion for several years. Pulmonary-specific enteral formulas have been designed to provide a higher fat and lower carbohydrate ratio due to the potential impact of carbon dioxide generation by carbohydrate. In one study of mechanically ventilated patients, a high fat, low carbohydrate diet resulted in decreased arterial carbon dioxide tension, improved minute volume and fewer days on ventilation. However, this result is not a consistent finding, and research exists showing no clear benefit to use of disease specific enteral formula in critically ill patients with hyperglycemia. Excessive fat intake can have implications for gastrointestinal tolerance, inflammation and cell dynamics. In addition, critically ill patients may also be receiving lipid-based sedatives, such as propofol, which further increases fat intake. These factors should be weighed against the strength of evidence in support of a high fat, low carbohydrate. Based upon this research, discuss the potential risks and benefits of providing a high-fat, low-carbohydrate enteral formula to pulmonary patients.
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