EN | TR
E-ISSN: 2602-2974
The Effect of Early Enteral Immunonutrition to Inflammatory Response for Intensive Care Patients
PDF
Cite
Share
Request
Original Research
VOLUME: 17 ISSUE: 2
P: 88-95
June 2019

The Effect of Early Enteral Immunonutrition to Inflammatory Response for Intensive Care Patients

J Turk Soc Intens Care 2019;17(2):88-95
DOI: 10.4274/tybd.galenos.2018.28290
Fatma Çelik 1
İpek Saadet Edipoğlu 2
1. Fırat Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Elazığ, Türkiye
2. İstanbul Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, İstanbul, Türkiye
No information available.
No information available
Received Date: 13.08.2018
Accepted Date: 21.09.2018
Publish Date: 31.05.2019
PDF
Cite
Share
Request

ABSTRACT

Objective:

Early enteral immunonutrition affects cytokine-dependent stress response, providing an optimal inflammatory and immune response in the dynamic process of SIRS through sepsis. In our study, we examined the inflammatory response of standard and glutamine products in the early and late nutrition regimen.

Materials and Methods:

Forty patients aged between 30 and 60 who needed ventilation support were randomly divided into 4 groups, namely standard early enteral (SE), standard late enteral (SG), early enteral immunonutrition (IE) and late enteral immunonutrition (IG). In early enteral nutrition groups, nutrition started within the first 24 hours of treatment and after 72 hours in the late groups. Prealbumin, albumin, CRP, IL-6, IL-10, APACHE II and mortality were calculated.

Results:

There was no difference in terms of demographics. We found a decrease in the prealbumin level in the SE group (p<0.05). There was a decrease in CRP levels in the IE and IG groups compared to SG group. There was an increase in SE group at 5th and 7th days (p<0.05). In terms of IL-6 levels, we found a decrease in the IE, SE, IG groups compared to SG group. In the IE group, IL-6 level was decreased compared to IG and SE groups at the 7th day. IL-10 level in the IG group increased at 5th and 7th days. APACHE II scores at 5th day were higher in the IG group compared to SG group. There was no difference in terms of mortality.

Conclusion:

It was concluded that glutamine-rich early enteral immunonutrition efficiently suppressed the systemic inflammatory response without affecting mortality and biochemical parameters.

Keywords: Glutamine, early enteral nutrition, immunonutrition

References

1
Von Ruecker A, Schmidt-Wolf IG. Strategies to evaluate metabolic stress and catabolism by means of immunological variables. Clin Nutr 2000;19:147-56.
2
Suchner U, Kuhn KS, Fürst P. The scientific basis of immunonutrition. Proc Nutr Soc 2000;59:553-63.
3
Grimble RF. Nutritional modulation of immune function. Proc Nutr Soc 2001;60:389-97.
4
Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: a systematic review. Crit Care Med 2001;29:2264-70.
5
Alpers DH. Enteral feeding and gut atrophy. Curr Opin Clin Nutr Metab Care 2002;5:679-83.
6
Deitch EA, Winterton J, Li M, et al. The gut as a portal of entry for bacteremia. Role of protein malnutrition. Ann Surg 1987;205:681-92.
7
Alverdy JC, Laughlin RS, Wu L. Influence of the critically ill state on host-pathogen interactions within the intestine: gut-derived sepsis redefined. Crit Care Med 2003;31:598-607.
8
Stonden J, Bihari D. Immunonutrition: an update. Curr Opin Crit Care 2000;3:149-57.
9
Wyncoll D, Beale R. Immunologically enhanced enteral nutrition: current status. Curr Opin Crit Care 2001;7:128-32.
10
Griffiths RD. Specialized nutrition support in critically ill patients. Curr Opin Crit Care 2003;9:249-59.
11
Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr 2003;27:355-73.
12
Doig GS, Simpson F. The Australian and New Zealand Intensive Care Society Clinical Trials Group. Evidence-based guidelines for nutritional support of the critically ill: results of a binational guideline development conference. Carlton: Australian and New Zealand Intensive Care Society; 2005. (www.nutritioncare.org/WorkArea)
13
Kreymann KG, Berger MM, Deutz NE, et al. ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr 2006;25:210-23.
14
Koga Y, Fujita M, Yagi T, et al. Early enteral nutrition is associated with reduced in-hospital mortality from sepsis in patients with sarcopenia. J Crit Care. 2018;47:153-8.
15
Tian F, Heighes PT, Allingstrup MJ, et al. Early Enteral Nutrition Provided Within 24 Hours of ICU Admission: A Meta-Analysis of Randomized Controlled Trials. Crit Care Med 2018;46:1049-56.
16
Song J, Zhong Y, Lu X, et al. Enteral nutrition provided within 48 hours after admission in severe acute pancreatitis: A systematic review and meta-analysis. Medicine (Baltimore) 2018;97:e11871.
17
Haac B, Henry S, Diaz J, et al. Early Enteral Nutrition Is Associated with Reduced Morbidity in Critically Ill Soft Tissue Patients. Am Surg 2018;84:1003-9.
18
Koltka EN, Çelik M, Öztekin F, Sağıroğlu AE, Ömür D. Major ortopedik cerrahi uygulanan hastalarda ek besleme desteğinin etkileri. Klinik Gelişim Dergisi 2006;19:26-30.
19
Kyle UG, Genton L, Heidegger CP, et al. Hospitalized mechanically ventilated patients are at higher risk of enteral underfeeding than non-ventilated patients. Clin Nutr 2006;25:727-35.
20
Coeffier M, Marion R, Leplingard A, et al. Glutamine decreases interleukin-8 and interleukin-6 but not nitric oxide and prostaglandins e (2) production by human gut in-vitro. Cytokine 2002;18:92-7.
21
Marcel F, Noonan VK, Bélanger L, et al. Early versus late enteral feeding in patients with acute cervical spinal cord injury. Spine (Phila Pa 1976) 2008;29:175-80.
22
Houdijk AP, Rijnsburger ER, Jansen J, et al. Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma. Lancet 1998;352:772-6.
23
Chen DW, Wei Fei Z, Zhang YC, et al. Role of enteral immunonutrition in patients with gastric carcinoma undergoing major surgery. Asian J Surg 2005;28:121-4.
24
Slotwinski R, Olszewski WL, Slotkowski M, et al. Can the interleukin-1 receptor antagonist (IL-1ra) be a marker of anti-inflammatory response to enteral immunonutrition in malnourished patients after pancreaticoduodenectomy? JOP 2007;8:759-69.
25
Jones C, Palmer TE, Griffiths RD. Randomized clinical outcome study of critically ill patients given glutamine-supplemented enteral nutrition. Nutrition 1999;15:108-15.
26
Schulman AS, Willcuttss KF, Claridge JA, et al. Does the addition of glutamine to enteral feeds affect patient mortality? Crit Care Med 2005;33:2501-6.
27
Conejero R, Bonet A, Grau T, 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.
28
Doig GS, Simpson F, Swetman EA, et al. Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a randomized controlled trial. JAMA 2013;309:2130-8.
2024 ©️ Galenos Publishing House