Nutrition in Clinical Practice

 

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Nutrition in Clinical Practice, Vol. 19, No. 6, 563-574 (2004)
DOI: 10.1177/0115426504019006563

Invited Reviews

The Acute Respiratory Distress Syndrome: Role of Nutritional Modulation of Inflammation Through Dietary Lipids

Barry A. Mizock, MD* and Stephen J. DeMichele, PhD{dagger}

* Department of Medicine, Cook County Hospital, Chicago, Illinois; and {dagger} Strategic Research and Development, Ross Products Division, Abbott Laboratories, Columbus, Ohio

Correspondence: Barry A. Mizock, MD, Department of Medicine, Cook County Hospital, 1900 West Polk Street, Chicago, IL 60612. Electronic mail may be sent to bmizock{at}earthlink.net.

The acute respiratory distress syndrome (ARDS) is the most serious form of acute hypoxic respiratory failure. ARDS represents the expression of an acute, diffuse, inflammatory process in the lungs consequent to a variety of infectious and noninfectious conditions. It is characterized pathologically by damage to pulmonary epithelial and endothelial cells, with subsequent alveolar-capillary leak and exudative pulmonary edema. The main clinical features of ARDS include rapid onset of dyspnea, severe defects in gas exchange, and imaging studies demonstrating diffuse pulmonary infiltrates. The role of nutrition in the management of ARDS has traditionally been supportive. Recent research has demonstrated the potential of certain dietary oils (eg, fish oil, borage oil) to modulate pulmonary inflammation, thereby improving lung compliance and oxygenation, and reducing time on mechanical ventilation. This article reviews the alterations in the immune response that underlie ARDS, discusses the physiology of dietary oils as immunonutrients, summarizes animal and human studies that explore the therapeutic effects of dietary oils, and provides clinical recommendations for their use.


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