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June 12, 1987, Vol 257, No. 22 >
ARTICLE | June 12, 1987

Nutritional Management in Acute Respiratory Failure FREE

Susan K. Pingleton, MD; Gary S. Harmon, MD
[+] Author Affiliations

Reprint requests to the University of Kansas Medical Center, Division of Pulmonary and Critical Care Medicine, 39th and Rainbow Boulevard, Kansas City, KS 66103 (Dr Pingleton).


JAMA. 1987;257(22):3094-3099. doi:10.1001/jama.1987.03390220092027
Text Size: A A A
Published online
Article
References

Nutrition in the intensive care unit is receiving increased attention. Patients with acute respiratory failure from primary lung disease are often initially malnourished, or become malnourished secondary to increased metabolic demands or inadequate nutritional support. Adverse effects of malnutrition on lung function include decreased respiratory muscle function, decreased ventilatory drive, and altered lung defense mechanisms. Nutritional support should be strongly considered if the patient has evidence of malnutrition by nutritional assessment or has a high likelihood of becoming malnourished by virtue of severe, prolonged critical illness. General nutritional goals in the intensive care unit include maintenance of body weight and lean body mass. Proper nutritional therapy includes assessment of adequate caloric requirements and appropriate protein, carbohydrate, and fat composition of the nutritional support. Nutritional therapy should be closely monitored with body weight and nitrogen-balance measurements.

(JAMA 1987;257:3094-3099)

REFERENCES

1 +
Driver AG, McAlevy MT, Smith JL:  Nutritional assessment of patients with chronic obstructive pulmonary disease and acute respiratory failure . Chest 1982;;82:568-571.
2 +
Pingleton SK, Eulberg M:  Nutritional analysis of acute respiratory failure patients . Chest 1983;; 84( (A) ):343.
3 +
Rochester DF, Esau SA:  Malnutrition and respiratory system . Chest 1984;;85:411-415.
4 +
Thomas L, Gerard M, Malquarti V, et al:  Etat nutritional des malades admis en reanimation: Relation avec la mortalite . Nouv Presse Med 1979;; 8:409-414.
5 +
Driver AG, LeBrun M:  Iatrogenic malnutrition in patients receiving ventilatory support . JAMA 1980;;244:2195-2196.
6 +
Bassili HR, Deitel M:  Effect of nutritional support on weaning patients off mechanical ventilation . JPEN 1981;;5:161-163.
7 +
Lorca L, Greenbaum DM:  Effectiveness of intensive nutritional regimens in patients who fail to wean from mechanical ventilation . Crit Care Med 1982;;10:297-300.
8 +
Askanazi J, Hensle T, Starker P, et al:  Effect of immediate postoperative nutritional support on length of hospitalization . Ann Surg 1986;;203:236-239.
9 +
Starker PM, LaSala PA, Askanazi J, et al:  The influence of preoperative total parenteral nutrition upon morbidity and mortality . Surg Gynecol Obstet 1986;;162:569-574.
10 +
Hunter AMB, Carey MA, Larsh HU:  The nutritional status of patients with chronic obstructive pulmonary disease . Am Rev Respir Dis 1981;; 124:376-381.
11 +
Butterworth CE:  The skeleton in the hospital closet . Nutr Today 1974;;9:4-8.
12 +
Harmon G, Pingleton SK, Hanson FN, et al:  Computer assisted nutritional therapy (CANT) in the intensive care unit , abstracted. Am Rev Respir Dis 1985;;131( (A) ):152.
13 +
Rochester DF, Braun NMT:  Determinants of maximal inspiratory pressure in chronic obstructive pulmonary disease . Am Rev Respir Dis 1985;; 132:42-47.
14 +
Braun NMT, Arora NS, Rochester DF:  Respiratory muscle and pulmonary function in proximal myopathies . Thorax 1983;;38:616-623.
15 +
Long CL, Birkham RH, Geiger JW:  Contribution of skeletal muscle protein in elevated rates of whole body protein catabolism in trauma patients . Am J Clin Nutr 1981;;34:1087-1093.
16 +
Thurlbeck WM:  Diaphragm and body weight in emphysema . Thorax 1978;;33:483-487.
17 +
Arora NS, Rochester DF:  Effect of body weight and muscularity on human diaphragm muscle mass, thickness and area . J Appl Physiol 1982;;52:64-70.
18 +
Rochester DF, Arora NS, Braun NMT:  Maximum contractile force of human diaphragm muscle, determined in vivo . Trans Am Clin Climatol Assoc 1981;;83:200-208.
19 +
Arora NS, Rochester DF:  Respiratory muscle strength and maximal voluntary ventilation in undernourished patients . Am Rev Respir Dis 1982;; 126:5-8.
20 +
Kelly SM, Rosa A, Field S, et al:  Inspiratory muscle strength and body composition in patients receiving total parenteral nutrition therapy . Am Rev Respir Dis 1984;;130:33-37.
21 +
Rochester DF, Briscoe AM:  Metabolism of the working diaphragm . Am Rev Respir Dis 1985;; 119:101-106.
22 +
Aubier M, Murciano D, Lecogguic Y, et al:  Effects of hypophosphatemia on diaphragmatic contractility in patients with acute respiratory failure . N Engl J Med 1985;;313:420-424.
23 +
Gertz I, Hedenstierna G, Hellers G, et al:  Muscle metabolism in patients with chronic obstructive lung disease and acute respiratory failure . Clin Sci Mol Med 1977;;52:395-403.
24 +
Wilson DO, Rogers RM, Sanders MH, et al:  Nutritional intervention in malnourished patients with emphysema . Am Rev Respir Dis 1986;;134: 672-677.
25 +
Doekel RC Jr, Zwillich CW, Scoggin CH, et al:  Clinical semistarvation: Depression of hypoxic ventilatory response . N Engl J Med 1976;;295:358-361.
26 +
Weissman C, Askanazi J, Rosenbaum S, et al:  Amino acids and respiration . Ann Intern Med 1983;;98:41-44.
27 +
McMurray D, Loomis S, Casazza L, et al:  Development of impaired ill-medicated immunity in mild and moderate nutrition . Am J Clin Nutr 1981;;34:68-77.
28 +
Stiehm ER:  Humoral immunity in malnutrition . Fed Proc 1980;;39:3093-3097.
29 +
Martin TR, Altman LC, Olvares OF:  The effects of severe protein-calorie malnutrition on antibacterial defense mechanisms in the rat lung . Am Rev Respir Dis 1983;;128:1013-1019.
30 +
Shennib H, Chiu RCJ, Mulder DS, et al:  Depression and delayed recovery of alveolar macrophage function during starvation and refeeding . Surg Gynecol Obstet 1984;;158:535-540.
31 +
Moriguchi S, Sone S, Kishino Y:  Changes of alveolar macrophages in protein-deficient rats . J Nutr 1983;;113:40-46.
32 +
Pingleton SK:  Complications of acute respiratory failure . Med Clin North Am 1983;;67:725-746.
33 +
Bell RC, Coalson JJ, Smith JD, et al:  Multiple organ system failure and infection in the adult respiratory distress syndrome . Ann Intern Med 1983;;98:593-597.
34 +
Johansen WG Jr, Pierce AK, Sanford JP, et al:  Nosocomial respiratory infections with gram-negative bacilli: The significance of colonization of the respiratory tract . Ann Intern Med 1972;;77:701-706.
35 +
Niederman MS, Merrill WW, Ferranti RD, et al:  Nutritional status and bacterial binding in the lower respiratory tract in patients with chronic tracheostomy . Ann Intern Med 1984;;100:795-800.
36 +
Koretz RL:  Breathing and feeding: Can you have one without the other? Chest 1984;;85:298-299.
37 +
Apelgren KN, Wilmore DW:  Nutritional care of the critically ill patient . Surg Clin North Am 1983;;63:497-507.
38 +
Lakshman K, Blackburn GL:  Monitoring nutritional status in the critically ill adult . J Clin Monit 1986;;2:114-120.
39 +
Wilson DO, Rogers RM, Hoffman RM:  Nutrition and chronic lung disease . Am Rev Respir Dis 1986;;132:1347-1365.
40 +
Silberman H, Eisenberg D: Parenteral and Enteral Nutrition for the Hospitalized Patient . East Norwalk, Conn, Appleton-Century-Crofts, 1982;, p 28.
41 +
Apelgren KN, Rombeau JL, Twomey RL, et al:  Comparison of nutritional undues and outcome in critically ill patients . Crit Care Med 1982;;10:305-307.
42 +
Ballard F, Tomas F:  3-Methylhistidine as a measure of skeletal muscle protein breakdown in human subjects: The case for its continued use . Clin Sci 1983;;65:209-215.
43 +
Ronnie M, Millward D:  3-Methylhistidine excretion and urinary 3-methylhistidine/creatinine ratio are poor indicators of skeletal muscle protein breakdown . Clin Sci 1983;;65:217-225.
44 +
Lewis R, Klein H:  Risk factors in post-operative sepsis: Significance of pre-operative lymphopenia . J Surg Res 1979;;26:365-371.
45 +
Kantar FS:  Infection, energy and cell-mediated immunology . N Engl J Med 1975;;292:629-634.
46 +
Buzby GP, Mullen JL, Matthews DC, et al:  Prognostic nutritional index in gastrointestinal surgery . Am J Surg 1980;;139:160-167.
47 +
Baker JP, Dersky AS, Wesson DG:  Nutritional assessment: Comparison of clinical judgement and objective measurements . N Engl J Med 1982;; 306:969-972.
48 +
Weir JB:  New methods for calculating metabolic rate with special reference to protein metabolism . J Physiol 1949;;109:1-9.
49 +
Whitman RA, Pingleton SK:  Variation in VO2 between room air and high FIO2 in normal subjects using the Horizon MMC . Am Rev Respir Dis 1985;;131( (A) ):93.
50 +
Damask MC, Askanazi J, Weissman C, et al:  Artifacts in measurement of resting energy expenditure . Crit Care Med 1983;;11:750-752.
51 +
Shike M, Russell D McR, Detsky AS, et al:  Changes in body composition in patients with small cell cancer: The effect of total parenteral nutrition as an adjunct to chemotherapy . Ann Intern Med 1984;;101:303-309.
52 +
Kinney JM, Duke JH, Long CL, et al:  Carbohydrate and nitrogen metabolism after injury . J Clin Pathol 1970;;23( (S) ):65-69.
53 +
Long CL, Schaffel N, Geiger JW:  Metabolic response to injury and illness: Estimation of energy and protein needs from indirect calorimetry and nitrogen balance . JPEN 1979;;3:453-456.
54 +
Lemoyne M, Jeejeeboy KN:  Total parenteral nutrition in the critically ill patient . Chest 1986;; 89:568-575.
55 +
Weissman C, Kemper M, Elwyn D, et al:  The energy expenditure of the mechanically ventilated critically ill patient . Chest 1986;;89:254-259.
56 +
Roulet M, Detsky AS, Marliss EB, et al:  A controlled trial of the effect of parenteral nutritional support on patients with respiratory failure and sepsis . Clin Nutr 1983;;2:97-105.
57 +
Harmon GS, Pingleton SK:  Energy (calorie) requirements in mechanically ventilated COPD patients . Am Rev Respir Dis 1986;;131( (A) ):203.
58 +
Baker JP, Detsky AS, Stewart S, et al:  Randomized trial of total parenteral nutrition in critically ill patients: Metabolic effects of varying glucose-lipid rations as the energy source . Gastroenterology 1984;;87:53-59.
59 +
Elwyn DH, Kinney JM:  A unique approach to measuring total energy expenditure by indirect calorimetry advances , in Kinney JM (ed): Assessment of Energy Metabolism in Health and Disease: Report of the First Ross Conference on Medical Research . Columbus, Ohio, Ross Laboratories, 1980;, pp 59-62.
60 +
Griske T, Gurnshanthorgh G, Glauser FL:  Effects of carbohydrates on carbon dioxide excretion in patients with airway disease . Chest 1977;; 71:55-58.
61 +
Brown SE, Nagendran RC, McHugh JW, et al:  Effects of a large carbohydrate load on walking performance in chronic air-flow obstruction . Am Rev Respir Dis 1985;;132:960-962.
62 +
Covelli HD, Black JW, Olsen MS, et al:  Respiratory failure precipitated by high carbohydrate loads . Ann Intern Med 1981;;95:579-581.
63 +
Dark DS, Pingleton SK, Kerby GR:  Hypercapnia during weaning: A complication of nutritional support . Chest 1985;;88:141-143.
64 +
Sheldon GF, Peterson SR, Sanders R:  Hepatic dysfunction during hyperalimentation . Arch Surg 1978;;113:504-507.
65 +
VanDeyk K, Hempel V, Munch F, et al:  Influence of parenteral fat administration on pulmonary vascular system in man . Intens Care Med 1983;; 9:73-77.
66 +
Askanazi J:  Nutrition for the patient with respiratory failure: Glucose vs fat . Anesthesiology 1981;;54:373-377.
67 +
Ang SD, Daly JM:  Potential complications and monitoring of patients receiving total parenteral nutrition , in Rombeau JL, Caldwell MD (eds): Parenteral Nutrition . Philadelphia, WB Saunders Co, 1986;, pp 331-334.
68 +
Kosanovich JM, Dumler F, Horst M, et al:  Use of urea kinetics in the nutritional care of the acutely ill patient . JPEN 1985;;9:165-169.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Driver AG, McAlevy MT, Smith JL:  Nutritional assessment of patients with chronic obstructive pulmonary disease and acute respiratory failure . Chest 1982;;82:568-571.
2 +
Pingleton SK, Eulberg M:  Nutritional analysis of acute respiratory failure patients . Chest 1983;; 84( (A) ):343.
3 +
Rochester DF, Esau SA:  Malnutrition and respiratory system . Chest 1984;;85:411-415.
4 +
Thomas L, Gerard M, Malquarti V, et al:  Etat nutritional des malades admis en reanimation: Relation avec la mortalite . Nouv Presse Med 1979;; 8:409-414.
5 +
Driver AG, LeBrun M:  Iatrogenic malnutrition in patients receiving ventilatory support . JAMA 1980;;244:2195-2196.
6 +
Bassili HR, Deitel M:  Effect of nutritional support on weaning patients off mechanical ventilation . JPEN 1981;;5:161-163.
7 +
Lorca L, Greenbaum DM:  Effectiveness of intensive nutritional regimens in patients who fail to wean from mechanical ventilation . Crit Care Med 1982;;10:297-300.
8 +
Askanazi J, Hensle T, Starker P, et al:  Effect of immediate postoperative nutritional support on length of hospitalization . Ann Surg 1986;;203:236-239.
9 +
Starker PM, LaSala PA, Askanazi J, et al:  The influence of preoperative total parenteral nutrition upon morbidity and mortality . Surg Gynecol Obstet 1986;;162:569-574.
10 +
Hunter AMB, Carey MA, Larsh HU:  The nutritional status of patients with chronic obstructive pulmonary disease . Am Rev Respir Dis 1981;; 124:376-381.
11 +
Butterworth CE:  The skeleton in the hospital closet . Nutr Today 1974;;9:4-8.
12 +
Harmon G, Pingleton SK, Hanson FN, et al:  Computer assisted nutritional therapy (CANT) in the intensive care unit , abstracted. Am Rev Respir Dis 1985;;131( (A) ):152.
13 +
Rochester DF, Braun NMT:  Determinants of maximal inspiratory pressure in chronic obstructive pulmonary disease . Am Rev Respir Dis 1985;; 132:42-47.
14 +
Braun NMT, Arora NS, Rochester DF:  Respiratory muscle and pulmonary function in proximal myopathies . Thorax 1983;;38:616-623.
15 +
Long CL, Birkham RH, Geiger JW:  Contribution of skeletal muscle protein in elevated rates of whole body protein catabolism in trauma patients . Am J Clin Nutr 1981;;34:1087-1093.
16 +
Thurlbeck WM:  Diaphragm and body weight in emphysema . Thorax 1978;;33:483-487.
17 +
Arora NS, Rochester DF:  Effect of body weight and muscularity on human diaphragm muscle mass, thickness and area . J Appl Physiol 1982;;52:64-70.
18 +
Rochester DF, Arora NS, Braun NMT:  Maximum contractile force of human diaphragm muscle, determined in vivo . Trans Am Clin Climatol Assoc 1981;;83:200-208.
19 +
Arora NS, Rochester DF:  Respiratory muscle strength and maximal voluntary ventilation in undernourished patients . Am Rev Respir Dis 1982;; 126:5-8.
20 +
Kelly SM, Rosa A, Field S, et al:  Inspiratory muscle strength and body composition in patients receiving total parenteral nutrition therapy . Am Rev Respir Dis 1984;;130:33-37.
21 +
Rochester DF, Briscoe AM:  Metabolism of the working diaphragm . Am Rev Respir Dis 1985;; 119:101-106.
22 +
Aubier M, Murciano D, Lecogguic Y, et al:  Effects of hypophosphatemia on diaphragmatic contractility in patients with acute respiratory failure . N Engl J Med 1985;;313:420-424.
23 +
Gertz I, Hedenstierna G, Hellers G, et al:  Muscle metabolism in patients with chronic obstructive lung disease and acute respiratory failure . Clin Sci Mol Med 1977;;52:395-403.
24 +
Wilson DO, Rogers RM, Sanders MH, et al:  Nutritional intervention in malnourished patients with emphysema . Am Rev Respir Dis 1986;;134: 672-677.
25 +
Doekel RC Jr, Zwillich CW, Scoggin CH, et al:  Clinical semistarvation: Depression of hypoxic ventilatory response . N Engl J Med 1976;;295:358-361.
26 +
Weissman C, Askanazi J, Rosenbaum S, et al:  Amino acids and respiration . Ann Intern Med 1983;;98:41-44.
27 +
McMurray D, Loomis S, Casazza L, et al:  Development of impaired ill-medicated immunity in mild and moderate nutrition . Am J Clin Nutr 1981;;34:68-77.
28 +
Stiehm ER:  Humoral immunity in malnutrition . Fed Proc 1980;;39:3093-3097.
29 +
Martin TR, Altman LC, Olvares OF:  The effects of severe protein-calorie malnutrition on antibacterial defense mechanisms in the rat lung . Am Rev Respir Dis 1983;;128:1013-1019.
30 +
Shennib H, Chiu RCJ, Mulder DS, et al:  Depression and delayed recovery of alveolar macrophage function during starvation and refeeding . Surg Gynecol Obstet 1984;;158:535-540.
31 +
Moriguchi S, Sone S, Kishino Y:  Changes of alveolar macrophages in protein-deficient rats . J Nutr 1983;;113:40-46.
32 +
Pingleton SK:  Complications of acute respiratory failure . Med Clin North Am 1983;;67:725-746.
33 +
Bell RC, Coalson JJ, Smith JD, et al:  Multiple organ system failure and infection in the adult respiratory distress syndrome . Ann Intern Med 1983;;98:593-597.
34 +
Johansen WG Jr, Pierce AK, Sanford JP, et al:  Nosocomial respiratory infections with gram-negative bacilli: The significance of colonization of the respiratory tract . Ann Intern Med 1972;;77:701-706.
35 +
Niederman MS, Merrill WW, Ferranti RD, et al:  Nutritional status and bacterial binding in the lower respiratory tract in patients with chronic tracheostomy . Ann Intern Med 1984;;100:795-800.
36 +
Koretz RL:  Breathing and feeding: Can you have one without the other? Chest 1984;;85:298-299.
37 +
Apelgren KN, Wilmore DW:  Nutritional care of the critically ill patient . Surg Clin North Am 1983;;63:497-507.
38 +
Lakshman K, Blackburn GL:  Monitoring nutritional status in the critically ill adult . J Clin Monit 1986;;2:114-120.
39 +
Wilson DO, Rogers RM, Hoffman RM:  Nutrition and chronic lung disease . Am Rev Respir Dis 1986;;132:1347-1365.
40 +
Silberman H, Eisenberg D: Parenteral and Enteral Nutrition for the Hospitalized Patient . East Norwalk, Conn, Appleton-Century-Crofts, 1982;, p 28.
41 +
Apelgren KN, Rombeau JL, Twomey RL, et al:  Comparison of nutritional undues and outcome in critically ill patients . Crit Care Med 1982;;10:305-307.
42 +
Ballard F, Tomas F:  3-Methylhistidine as a measure of skeletal muscle protein breakdown in human subjects: The case for its continued use . Clin Sci 1983;;65:209-215.
43 +
Ronnie M, Millward D:  3-Methylhistidine excretion and urinary 3-methylhistidine/creatinine ratio are poor indicators of skeletal muscle protein breakdown . Clin Sci 1983;;65:217-225.
44 +
Lewis R, Klein H:  Risk factors in post-operative sepsis: Significance of pre-operative lymphopenia . J Surg Res 1979;;26:365-371.
45 +
Kantar FS:  Infection, energy and cell-mediated immunology . N Engl J Med 1975;;292:629-634.
46 +
Buzby GP, Mullen JL, Matthews DC, et al:  Prognostic nutritional index in gastrointestinal surgery . Am J Surg 1980;;139:160-167.
47 +
Baker JP, Dersky AS, Wesson DG:  Nutritional assessment: Comparison of clinical judgement and objective measurements . N Engl J Med 1982;; 306:969-972.
48 +
Weir JB:  New methods for calculating metabolic rate with special reference to protein metabolism . J Physiol 1949;;109:1-9.
49 +
Whitman RA, Pingleton SK:  Variation in VO2 between room air and high FIO2 in normal subjects using the Horizon MMC . Am Rev Respir Dis 1985;;131( (A) ):93.
50 +
Damask MC, Askanazi J, Weissman C, et al:  Artifacts in measurement of resting energy expenditure . Crit Care Med 1983;;11:750-752.
51 +
Shike M, Russell D McR, Detsky AS, et al:  Changes in body composition in patients with small cell cancer: The effect of total parenteral nutrition as an adjunct to chemotherapy . Ann Intern Med 1984;;101:303-309.
52 +
Kinney JM, Duke JH, Long CL, et al:  Carbohydrate and nitrogen metabolism after injury . J Clin Pathol 1970;;23( (S) ):65-69.
53 +
Long CL, Schaffel N, Geiger JW:  Metabolic response to injury and illness: Estimation of energy and protein needs from indirect calorimetry and nitrogen balance . JPEN 1979;;3:453-456.
54 +
Lemoyne M, Jeejeeboy KN:  Total parenteral nutrition in the critically ill patient . Chest 1986;; 89:568-575.
55 +
Weissman C, Kemper M, Elwyn D, et al:  The energy expenditure of the mechanically ventilated critically ill patient . Chest 1986;;89:254-259.
56 +
Roulet M, Detsky AS, Marliss EB, et al:  A controlled trial of the effect of parenteral nutritional support on patients with respiratory failure and sepsis . Clin Nutr 1983;;2:97-105.
57 +
Harmon GS, Pingleton SK:  Energy (calorie) requirements in mechanically ventilated COPD patients . Am Rev Respir Dis 1986;;131( (A) ):203.
58 +
Baker JP, Detsky AS, Stewart S, et al:  Randomized trial of total parenteral nutrition in critically ill patients: Metabolic effects of varying glucose-lipid rations as the energy source . Gastroenterology 1984;;87:53-59.
59 +
Elwyn DH, Kinney JM:  A unique approach to measuring total energy expenditure by indirect calorimetry advances , in Kinney JM (ed): Assessment of Energy Metabolism in Health and Disease: Report of the First Ross Conference on Medical Research . Columbus, Ohio, Ross Laboratories, 1980;, pp 59-62.
60 +
Griske T, Gurnshanthorgh G, Glauser FL:  Effects of carbohydrates on carbon dioxide excretion in patients with airway disease . Chest 1977;; 71:55-58.
61 +
Brown SE, Nagendran RC, McHugh JW, et al:  Effects of a large carbohydrate load on walking performance in chronic air-flow obstruction . Am Rev Respir Dis 1985;;132:960-962.
62 +
Covelli HD, Black JW, Olsen MS, et al:  Respiratory failure precipitated by high carbohydrate loads . Ann Intern Med 1981;;95:579-581.
63 +
Dark DS, Pingleton SK, Kerby GR:  Hypercapnia during weaning: A complication of nutritional support . Chest 1985;;88:141-143.
64 +
Sheldon GF, Peterson SR, Sanders R:  Hepatic dysfunction during hyperalimentation . Arch Surg 1978;;113:504-507.
65 +
VanDeyk K, Hempel V, Munch F, et al:  Influence of parenteral fat administration on pulmonary vascular system in man . Intens Care Med 1983;; 9:73-77.
66 +
Askanazi J:  Nutrition for the patient with respiratory failure: Glucose vs fat . Anesthesiology 1981;;54:373-377.
67 +
Ang SD, Daly JM:  Potential complications and monitoring of patients receiving total parenteral nutrition , in Rombeau JL, Caldwell MD (eds): Parenteral Nutrition . Philadelphia, WB Saunders Co, 1986;, pp 331-334.
68 +
Kosanovich JM, Dumler F, Horst M, et al:  Use of urea kinetics in the nutritional care of the acutely ill patient . JPEN 1985;;9:165-169.

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