The hazards of hypercaloric nutritional support in respiratory disease.

: This case illustrates the dangers of hypercaloric feeding in a patient with limited respiratory reserve, in this instance secondary to heart-lung transplantation. The patient's postoperative course was complicated by repeated bouts of infection and/or rejection that resulted in intubation and ventilatory support. The excessive caloric and protein load given to the patient resulted in increased CO2 generation with subsequent inability to wean the patient off the ventilator. Recognition of the problem and appropriate decreases in substrate intake permitted extubation.