medigraphic.com
ISSN 2594-1518 (Electronic)
ISSN 1405-0099 (Print)

2011, Number 4

<< Back Next >>

Cir Gen 2011; 33 (4)

Influence of immunonutrition on the general and nutritional state, and on the in-hospital stay, of patients operated secondary to abdominal sepsis

González-Calatayud M, López-Romero S, Athié-Gutiérrez C, Valdovinos-González C, Urbina-León D

Language: Spanish
References: 33
Page: 236-242
PDF size: 88.03 Kb.


ABSTRACT

Objective: To assess the effect of glutamine, together with early enteral nutrition in patients with surgically resolved abdominal sepsis, on the general health status (Apache II), protein catabolism (urinary urea nitrogen test), complications, and duration of in-hospital stay.
Setting: General Hospital of Mexico.
Design: Controlled clinical trial.
Statistical analysis: Student’s t test.
Method: We chose 24 patients with abdominal sepsis from the Emergency Ward in the General Hospital of Mexico, who required surgical resolution. After 24 to 72 h of the surgery, enteral nutrition was started in two groups: the first with glutamine plus standard nutrition and the second with standard nutrition. On days 1 and 3 of the postoperative period, laboratory tests were performed and urinary urea nitrogen was measured to determine Apache II classification, infectious and non-infectious complications, the nitrogen balance, and duration of in-hospital stay.
Results: No statistically significant difference was found in any of the measured parameters between the two groups (glutamine and control); however, a significant difference was found in the value of the Apache II in the glutamine group when compared intragroup on the first and third days (p ‹ 0.05).
Conclusions: Early enteral nutrition supplemented with glutamine does not reveal an early difference in terms of the metabolic response to trauma, nutritional state, or protein utilization.


REFERENCES

  1. Wischmeyer PE. Glutamine: Mode of action in critical illness. Crit Care Med 2007; 35(9 Suppl.): S541-S544.

  2. Mier J, et al. Complicaciones de la apendicectomía. La importancia del diagnóstico temprano. Cir Cir 1994; 62: 132-7.

  3. Masters B, Doos D. Nutrition aupport in burns —is there consistency in practice. J Burn Care Res 2008; 29: 561-571.

  4. Huckleberry Y. Nutritional support and the surgical patient. Am J Health Syst Pharm 2004; 61: 671-682.

  5. Nehra V. Fluid electrolyte and nutritional problems in the postoperative period. Clin Obstet Gynecol 2002; 45: 537-544.

  6. Sigalet DL, Mackenzie SL, Harmeed SM. Enteral nutrition and mucosal immunity: Implications for feeding strategies in surgery and trauma. Can J Surg 2004; 47: 109-116.

  7. Matsuda A , Furukawa K, Takasaki H, Suzuki H, Kan H, Tsuruta H, et al. Preoperative oral immune-enhancing nutritional supplementation corrects Th1/Th2 imbalance in patients undergoing elective surgery for colorectal cancer. Dis Colon Rectum 2006; 49: 507-516.

  8. Elke G, Schädler D, Ebgek C, Bogatsch H, Frerichs I, Ragaller M, et al. German Competence Network Sepsis (SepNet). Current practice in nutritional support and its association with mortality in septic patients —results from a national, prospective, multicenter study. Crit Care Med 2008; 36: 1762-1767.

  9. Beale RJ, Sherry T, Lei K, Campbell-Stephen L, McCook J, Smith J, et al. Early enteral supplementation with key pharmaconutrients improves Sequential Organ Failure Assesment Score in critically ill patients with sepsis: outcome of randomized, controlled, doble-blind trial. Crit Care Med 2008; 36: 131-144.

  10. Luiking YC, Deutz NE. Exogenous arginine in sepsis. Crit Care Med 2007; 35(9 suppl): S557-S563.

  11. Vincent JL. Metabolic support in sepsis and multiple organ failure: more questions than answers. Crit Care Med 2007; 35(9 suppl): S436-440.

  12. ASPEN Board of Directors and the Clinical Guidelines Taskforce. Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients. JPEN J Parenter Enteral Nutr 2002; 26(suppl): 9SA-11SA.

  13. ASPEN Board of Directors and the Clinical Guidelines Taskforce. Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients. JPEN J Parenter Enteral Nutr 2002; 26(suppl):18-9SA.

  14. Kurmis Rm Parker A, Greenwood J. The use of immunonutrition in burn injury care: where are we? J Burn Care Rese 2010; 31: 677-691.

  15. Bergström J, Fürst P, Norée LO, Vinnars E. Intracellular free aminoacid concentration in human muscle tissue. J Appl Physiol 1974; 36: 693-697.

  16. Hankard RG, Darmaun D, Sager BK, D’Amore D, Parsons WR, Haymond M. Response of glutamine metabolism to exogenous glutamine in humans. Am J Physiol 1995; 269: E663–E670

  17. Bongers T, Griffiths RD, McArdle A. Exogenous glutamine: the clinical evidence. Crit Care Med 2007; 35(9 Suppl.): S545-S552

  18. Vinnars E, Bergström J, Fürst P. Influence of the postoperative state on the intracellular free aminoacids in human muscle tissue. Ann Surg 1975; 182: 665-671.

  19. Newsholme EA, Crabtree B, Ardawi MS. Glutamine metabolism in lymphocytes: Its biochemical, physiological and clinical importance. Q J Exp Physiol 1985; 70: 473-489.

  20. Wilmore DW: The effect of glutamine supplementation in patients following elective surgery and accidental injury. J Nutr 2001; 131(9 suppl): 2543S–2549S

  21. Duska F, FricM, Waldauf P, Pazout J, Andel M, Hodrejs P, et al. Frequent intravenous pulses of growth hormone together with glutamine supplementation in prolonged critical illness after multiple trauma: effects on nitrogen balance, insulin resistance, and substrate oxidation. Crit Care Med 2008; 36(6): 1707-1713.

  22. Bonetto A, Penna F, Minero VG, Reffo P, Costamagma D, Bonelli G, et al. Glutamine prevents myostatin hyperexpression and protein hypercatabolism induced in C2C12 myotubes by tumor necrosis factor-α. Amino Acids 2011. 40(2): 585-594.

  23. Petry ER, Alvarenga-Lindenberg M, Gomes-Thiago H, de Bittencourt-Homem PI, Fernandes-Vinicius C, Tirapegui J. Oral supplementation with alanyl-glutamine or glutamine prevents muscle damage and oxidative stress in trained rats: 2010: Board #12 June 5 8:00 AM - 9:30 AM. Medicine & Science in Sports & Exercise. 2010; 42(5) Supplement 1:792. doi: 10.1249/01.MSS.0000386451.47524.e4

  24. Kim YS, Jung MH, Choi YH, Sheverdin V, Kim JH, Ha HJ, et al. Glutamine attenuates tubular cell apoptosis in acute kidney injury via inhibition of the c-Jun N-terminal kinase phosphorylation of 14-3-3.Crit Care Med 2009; 37(6): 2033-2044.

  25. Kuhls DA, Rathmacher JA, Musngi MD, Frisch DA, Nielson J, Barber A, et al. Beta-hydroxy-beta-methylbutyrate supplementation in critically ill patients. J Trauma 2007; 62: 125-132.

  26. Gianotti L, Braga M, Biffi R, Bozzetti F, Mariani L; Glutamine Research Group of the Italian Society of Parenteral and Enteral Nutrition. Perioperative intravenus glutamine dupplementation in major abdominal surgery for cancer: a randomized multicenter trial. Ann Surg 2009; 250: 684-690.

  27. Novak F, Heyland DK, Avenell A, Drover JW, Su X. Glutamine supplementation in serious illness: a systematic review of the evidence. Crit Care Med 2002; 20: 2022-2029.

  28. Zheng YM, Li F, Zhang MM, Wu XT. Glutamine dipeptide for parenteral nutrition in abdominal surgery: a meta-analysis of randomized controlled trials. World J Gastroenterol 2006; 12: 7537-7541.

  29. Cetinbas F, Yelken B, Gulbas Z. Role of glutamine administration on cellular immunity after total parenteral nutrition enriched with glutamine in patients with systemic inflammatory response syndrome. J Crit Care 2010. 25(4): 661.e1-6.

  30. Grau T, Bonet A, Miñambres E, Piñero L, Irles JA, Robles A, et al. Metabolism, Nutrition Working Group, SEMICYUC. Spain. The effect of L-alanyl-L-glutamine dipeptide supplemented total parenteral nutrition on infectious morbidity and insulin sensitivity in critically ill patients. Crit Care Med 2011; 39: 1263-1268.

  31. Windle EM. Glutamine supplementation in critical illness: evidence, recommendations, and implications for clinical practice in burn care. J Burn Care Res 2006; 27: 764-772.

  32. Canadian Clinical Practice Guidelines Summary of Topics and Recommendations. May 28th, 2009.

  33. Pontes-Arruda A, Aragão AM, Alburqueque JD. Effects of enteral feeding with eicosapentaenoic acid, gamma-linoleic acid and antioxidants in mechanically ventilated patients with severe sepsis and septic shock. Crit Care Med 2006; 34: 2325-2333.




2020     |     www.medigraphic.com