Keywords
How to Cite
Abstract
Background & Objectives: This study investigated the effects for the addition of omega 3 fatty acids and glutamine-L-alanine to the standard enteral and/or parenteral nutrition regimen on infection and mortality in the critically ill patients after major abdominal surgery.
Methods: This is a prospective, randomized, single center study. A total of 43 patients (age range: 18-85 years), who were in the critical care unit after major abdominal surgery, were included. Patients were divided into two groups according to simple randomized selection [Control group, n=20; Study Group, n=23 (omega3 fatty acids and glutamine-L-alanine)] and were monitored for 21 days. Patients were examined for the assessment of APACHE II Score and existence of ALI (acute lung injury)/ARDS (acute respiratory distress syndrome) requiring mechanical ventilation. In addition to standard enteral or parenteral nutrition, patients in the study group were given parenteral pharmaconutrition products for 10 days postoperatively. Groups were compared for the duration of mechanical ventilation, duration of stay in the intensive care unit and hospitalization, and mortality. Laboratory parameters including CRP, TNF, IL6, IL8, nitrogen balance, albumin, and total lymphocyte count were recorded.
Results:Although the mean APACHE score was higher in study group in which patients received omega-3 fatty acids and glutamine-L-alanine support, the clinical infection rate seemed to decrease insignificantly.
Conclusions: A clinically decreased rate of infection was observed in patients with a high APACHE II score, or who received omega-3 fatty acids, glutamine-L-alanine, are required to be administered more selectively and in larger patient groups in different doses and in combination protocols in accordance with the current pharmaconutritional support and in different timing combinations, including preoperative period
References
Griffiths RD, Allen KD, Andrews FJ, Jones C. Infection, multiple organ failure and survival in the intensive care unit: influnce of glutamine supplemented parenteral nutrition on acquired infection. Nutrition 2002; 18: 546-52. http://dx.doi.org/10.1016/S0899-9007(02)00817-1
Galban C, Montejo JC, Mesejo A, Marco P, Celaya S, Sánchez-Segura JM, et al. An ?mmune-enhancing enteral diet reduces mortality and episodes of bacteremia in septic intensive care unit patients. Crit Care Med 2000; 28: 643-8. http://dx.doi.org/10.1097/00003246-200003000-00007
Horan TC, Andrus M, Dudek MA. CDC/NHSN surveillance definition of health care- associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36: 309-32. http://dx.doi.org/10.1016/j.ajic.2008.03.002
Atkinson S, Sieffert E, Bihari D. A prospective, randomized, double-blind, controlled clinical trial of enteral immunonutrition in the critically ill. Crit Care Med 1998; 26: 1164-72. http://dx.doi.org/10.1097/00003246-199807000-00013
Moore FA, Moore EE, Kudsk KA. Clinical benefits of an immune-enhancing diet for early postinjury enteral feding. J Trauma 1994; 37: 607-15. http://dx.doi.org/10.1097/00005373-199410000-00014
Bower RH, Cerra FB, Bershadsky B, Licari JJ, Hoyt DB, Jensen GL. et al. Early enteral administration of a formula supplemented with arginine, nucleotides and fish oil in intensive care unit patients: results of a multicenter, prospective, randomized clinical trial. Crit Care Med 1995; 23: 436-49. http://dx.doi.org/10.1097/00003246-199503000-00006
Weimann A, Bastian L, Bischoff WE, Grotz M, Hansel M, Lotz J. et al. Influence of arginine, omega-3 fatty acids and nucleotide supplemented enteral support on systemic inflammatory response syndrome and multiple organ failure in patients after severe trauma. Nutrition 1998; 14: 165-72. http://dx.doi.org/10.1016/S0899-9007(97)00429-2
Mendez C, Jurkovich GJ, Garcia I, Davis D, Parker A, Maier RV. Effects of an immune-enhancing diet in critically injured patients. J Trauma 1997; 42: 933-40. http://dx.doi.org/10.1097/00005373-199705000-00026
Heller AR, Rössler S, Litz RJ, Stehr SN, Heller SC, Koch R, et al. Omega-3 fatty acids improve the diagnosisrelated clinical outcome. Crit Care Med 2006; 34: 972-78. http://dx.doi.org/10.1097/01.CCM.0000206309.83570.45
Houdijk AP, Rijnsburger ER, Jansen J, Wesdorp RI, Weiss JK, Mc Camish MA, et al. Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma. Lancet 1998; 352: 772-6. http://dx.doi.org/10.1016/S0140-6736(98)02007-8
Hall JC, Dobb G, Hall J, de Sousa R, Brennan L, McCauley R. A prospective randomized trial of enteral glutamine in critical illness. Intensive Care Med 2003; 29: 1710-6. http://dx.doi.org/10.1007/s00134-003-1937-2
Jensen GL, Miller RH, Talabiska DG, Fish J, Gianferante L. A double-blind, prospective, randomized study of glutamine- enriched compared with standard peptide-based feeding in critically ill patients. Am J Clin Nutr 1996; 64: 615-21.
Jones C, Palmer TE, Griffiths RD. Randomized clinical outcome study of critically ill patients given Glutamine supplemented enteral nutrition. Nutrition 1999; 15: 108-15. http://dx.doi.org/10.1016/S0899-9007(98)00172-5
Senkal M, Geier B, Hannemann M, Deska T, Linseisen J, Wolfram G, et al. Supplementation of omega-3 fatty acids in parenteral nutrition beneficially alters phospholipid fatty acid pattern. J Parenter Enteral Nutr 2007; 31: 12-7. http://dx.doi.org/10.1177/014860710703100112
Gadek JE, DeMichele SJ, Karlstad MD, Pacht ER, Donahoe M, Albertson TE. et al. Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic asid and antioxidants reduces alveolar inflammatory mediators and protein influx in patients with acute respiratory distress syndrome. Crit Care Med 2003; 31: 491-500. http://dx.doi.org/10.1097/01.CCM.0000049952.96496.3E
Schroeder J, Alteheld B, Stehle P, Cayeux MC, Chioléro RL, Berger MM. Safety and intestinal tolerance of high-dose enteral antioxidants and glutamine peptides after upper gastrointestinal surgery. Eur J Clin Nutr 2005; 59: 307-10. http://dx.doi.org/10.1038/sj.ejcn.1602073
Conejero R, Bonet A, Grau T, Esteban A, Mesejo A, Montejo JC, et al. Effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity at 28 days in critically ill patients with systemic inflammatory response syndrome: a randomized, single-blind, prospective, multicenter study. Nutrition 2002; 18: 716-21. http://dx.doi.org/10.1016/S0899-9007(02)00847-X
Zhou YP, Jiang ZM, Sun YH, Wang XR, Ma EL, Wilmore D. The effect of supplemental enteral glutamine on plasma levels, gut function, and outcome in severe burns: a randomized, double-blind, controlled clinical trial. JPEN J Parenter Enteral Nutr 2003; 27: 241-5. http://dx.doi.org/10.1177/0148607103027004241
Liang B, Wang S, Ye YJ, Yang XD, Wang YL, Qu J. et al. Impact of postoperative omega-3 fatty acid supplemented nutrition on clinical outcomes and immunmodulations in colorectal cancer patients. World J Gastroenterol 2008; 21: 2434-9. http://dx.doi.org/10.3748/wjg.14.2434
Schroeder J, Alteheld B, Stehle P, Cayeux MC, Chioléro RL, Berger MM. Safety and intestinal tolerance of high-dose enteral antioxidants and glutamine peptides after upper gastrointestinal surgery. Eur J Clin Nutr 2005; 59: 307-10. http://dx.doi.org/10.1038/sj.ejcn.1602073
Senkal M, Haaker R, Deska T, Hummel T, Steinfort C, Zumtobel V, et al. Early enteral gut feeding with conditionally indispensable pharmaconutrients is metabolically safe and is well tolerated in postoperative cancer patients: a pilot study. Clin Nutr 2004; 23: 1193-8. http://dx.doi.org/10.1016/j.clnu.2004.03.010
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. An evaluation of outcome intensive care ein major medical centers. Ann Intern Med 1986; 104: 410-8. http://dx.doi.org/10.7326/0003-4819-104-3-410
Grecu I, Mirea L, Gintescu I. Parenteral fish oil supplementation in patients with abdominal sepsis. Clin Nutr 2003; 22(S1): 23. http://dx.doi.org/10.1016/S0261-5614(03)80086-9
Goeters C, Wenn A, Mertes N, Wempe C, Van Aken H, Stehle P, et al. Parenteral L-alanyl-L-glutamine improves 6-month outcome in critically ill patients. Crit Care Med 2002; 30: 2032-7. http://dx.doi.org/10.1097/00003246-200209000-00013
Novak F, Heyland DK, Avenell A, et al. Glutamine supplementation in serious illness: a systematic review of the evidence. Crit Care Med 2002; 30: 2022-9. http://dx.doi.org/10.1097/00003246-200209000-00011
Wischmeyer PE, Lynch J, Liedel J, Wolfson R, Riehm J, Gottlieb L, et al. Glutamine administration reduces gram-negative bactremia in severely burned patients: A prospective, randomized, double-blind trial versus isonitrogeneus control. Crit Care Med 2001; 29: 2075-80. http://dx.doi.org/10.1097/00003246-200111000-00006
Galban C, Montejo JC, Mesejo A, Marco P, Celaya S, Sánchez-Segura JM et al. An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients. Crit Care Med 2000; 28: 643-8. http://dx.doi.org/10.1097/00003246-200003000-00007
Bower RH, Cerra FB, Bershadsky B, Licari JJ, Hoyt DB, Jensen GL, et al. Early enteral administration of a formula (Impact) supplemented with arginine, nucleotides, and fish oil in intensive care unit patients: results of a multicenter, prospective, randomized, clinical trial. Crit Care Med 1995; 23: 436-49. http://dx.doi.org/10.1097/00003246-199503000-00006
Heyland DK, Novak F, Drover JW, Jain M, Su X, Suchner U. Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. JAMA 2001; 286: 944-53. http://dx.doi.org/10.1001/jama.286.8.944
Heys SD, Walker LG, Smith I, Eremin O. Enteral nutritional supplementation with key nutrients in patients with critical illness and cancer: a meta-analysis of randomized controlled trials. Ann Surg 1999; 229: 467-77. http://dx.doi.org/10.1097/00000658-199904000-00004
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2014 Kaya Bulut Gulsen, Ozgultekin Asu, Turan Guldem, Isıtmangil Gulbu, Terzioglu Ufuk, Kurt Nurettin , Ekinci Osman