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Shahin Barakat1, Germain Michele2, Pastene George3, Viallet Nicole4, Annat Guy51Master of (experimental physiopathology) and doctoral student of physiopathology; 2Chef of the service of EFR, Hospital of the Croix-Rousse at Lyon, France; 3Hospital of Croix-Rousse at Lyon, France; 5Service of EFR, Hospital of the Croix Rousse at Lyon, France; 5UFR Médecine Lyon Grange-Blanche Université Claude Bernard Lyon I, INSERM ESPRI ERI 22, Lyon, FranceObjective: To evaluate an entirely outpatient-based program of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease COPD, using St.George’s Respiratory questionnaire (SGRQ), the 6-minutes walking test (6-MWT) and BODE index as the primary outcome measures.Methods: A prospective, parallel-group controlled study of an outpatient rehabilitation program in 80 patients with COPD (67 men and 13 women; mean age 64.8 ± 10.6 years; FEV1, 42.8% ± 7.6% of the predicted value. The active group (n = 40) took part in a 14-week rehabilitation program [3 h/wk, 1.5 h of education and exercise and 1.5 h of cycling]. The control group (n = 40) was reviewed routinely as medical outpatients. The following evaluations were carried out at study entry and after 14weeks: (1) pulmonary function studies; (2) 6-minutes walking test 6MWT; (3) quality of life; and (4) BODE index.Results: The following patients completed the study: 35 patients (87.5%) from the active group (mean age, 63.7 ± 11.9 years; mean forced expiratory volume in one second (FEV1), 41.9 ± 2.6% of the predicted value); and 36 patients (88%) from the control group (mean age, 65.9 ± 10.3 years; mean FEV1, 43.33 ± 3.6% of the predicted value). We found no changes in pulmonary function parameters in the active group and the control one at 14weeks. On the other hand, there were significant changes within the components of the SGRQ (12.3 for the score total) for the patients of the active group but not for the patients of the control one (only 1.5 for the score total), we observed also a significant increase in the distance of the 6-MWT in the patients of the active group but not for the patients of the control one, and finally a decrease of two points (from 6 to 4) was noted in the score of the active group’s BODE index without any change in the control group’s one.Conclusion: An outpatient-based of 14-week rehabilitation program significantly improved the quality of life and exercise tolerance without any change in the pulmonary function in patients with moderate COPD, and there was also a large decrease in the risk of death in rehabilitated patients as measured using the BODE index.Keywords: COPD, quality of life, pulmonary rehabilitation, 6-minute walking test, BODE index

The effects of long- and medium-chain triglycerides (LCT, MCT) administered as parenteral nutritional support on the rate of carbohydrate or lipid oxidation were analyzed in hyperglycemic and hyperinsulinemic patients. Shifting of parenteral nutritional support from LCT to a mixture of MCT-LCT did not alter lipid oxidation rates in patients with hyperinsulinemia and hyperglycemia. Furthermore, modification of parenteral nutritional support did not affect nitrogen balance and carbohydrate oxidation in critically ill patients.

A study conducted on glucose metabolism in patients in the intensive care unit (ICU) shows that lipids present in the parenteral nutritive fluids do not change hepatic glucose production, glucose recycling rate or carbohydrate oxidation rate, but do increase the free fatty acid level marginally. An infusion of lipids and long-chain triglycerides causes deposition of fats. Thus, lipids do not change the metabolism of glucose in ICU patients and almost 45% of the lipids are accumulated in the body.

Analysis of the influences of glucose-to-lipid ratio and lipid type on substrate oxidation rate in post-operative patients reveals that large quantities of lipid, a mixture of long and medium-chain triglycerides (MCT/LCT) or long chain triglycerides LCT, do not affect oxidation rate in post-operative patients. Enhancing the level of lipids in parenteral nutrition for 24-h periods causes a minimal increase in lipid oxidation rate and does not reduce the minute ventilation when total caloric uptake is fixed at the estimated energy expenditure.

Measurement of the nutrient oxidation rate with 3C as a tracer requires knowledge of the value of its coefficient of fractional recovery in the expired gas (FR). We measured FR in nine intensive care patients who were mechanically ventilated and received total parenteral nutrition. NaH13CO3 was administered at a priming dose (3.75 µmol • kg-1 • min-1) followed by a continuous infusion (0.05 µmol • kg-1 • min-1). Metabolic rate and pulmonary carbon dioxide elimination (VCO2) were measured by using a mass-spectrometer system. The 13C-12C ratio was measured in the expired gas with an isotopic-ratio mass spectrometer and FR was calculated by using standard equations. The average value of FR was 0.899 ± 0.026 (¯ ± SE) and remained stable for each patient on 2 consecutive days. Between patients, the coefficient of variation of FR was 8.6%. Metabolic rate was the only physiological factor found to affect the FR value. [ABSTRACT FROM AUTHOR]