Many patients with chronic respiratory failure lack good nutrition care in small hospital in Taiwan. We operated an effective nutrition care program in the respiratory treatment center of a small 100-bed hospital. In the beginning, we observed and collected basic information about patients, including gender, age, anthropometry, on ventilation or not, and nutrition status, in a 6-month study period, 37 patients were subjects (19 male, 18 female), 84% of the patients were between 70 to 90 y/o. The nutrition status upon admission was that only 37.8% of the patients had a normal range of BMI (Body Mass Index; 22+10%), and 56.8% of the patients were under the normal range. Serum albumin was above 3.5mg/dl in 46% of the patients, between 3.0 and 3.5 in 32% of the patients and under 3.0 in 22% of the patients. 70% of the patients were on mechanical ventilation upon admission; 19.2% of these patients could be totally weaned from ventilation, and 30.7% of the patients could be weaned from ventilation for at least 1 week, but 46% of the patients remained on ventilation.
The mortality was 35%, and those whose body weight was less than 90% of ideal body weight seemed to have a higher mortality (50%), and mortality in those who had normal weight was 26.6%. With an aggressive nutrition support system for our patients, we tried to arrange an ideal clinical pathway of nutrition care including nutrition assessment, feeding method, feeding route, follow up & monitor feeding tolerance, and nutrition status. After 6 month of clinical practice, we observed the following results: all patients (37 people) had enteral nutrition support by intermittent bolus feeding 6 times per day; 54% of the patients had 200-300cc feeding volume each time, and 38% of the patients had more than 300cc. The usual concentration is 1kcal/cc. Two major feeding formulas we used were standard formula (Nutri-Aid), and pulmo formula (Pulmo-Aid). Most of patients (64.8%) required 1500-1800 calories, and 65% of the patients could meet their calorie requirement in 3 days, and 14% of the patients also met calorie requirement in 3-5 days. The feeding tolerance was well accepted, because the frequency of feeding complications was as such diarrhea was 1.6%, vomiting was 1.9%, distension was 1.9%, and constipation was 0.25%, Coffee ground was 2.7% and should be noted.