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Synbiotics, Prebiotics, Glutamine, or Peptide in Early Enteral Nutrition: A Randomized Study in Trauma Patients
Author(s) -
SpindlerVesel Alenka,
Bengmark Stig,
Vovk Irena,
Cerovic Ognjen,
Kompan Lidija
Publication year - 2007
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607107031002119
Subject(s) - lactulose , synbiotics , medicine , glutamine , intestinal permeability , enteral administration , gastroenterology , parenteral nutrition , mannitol , excretion , mechanical ventilation , intensive care unit , probiotic , chemistry , biology , biochemistry , amino acid , bacteria , genetics
Background: Since the hepatosplanchnic region plays a central role in development of multiple‐organ failure and infections in critically ill trauma patients, this study focuses on the influence of glutamine, peptide, and synbiotics on intestinal permeability and clinical outcome. Methods: One hundred thirteen multiple injured patients were prospectively randomized into 4 groups: group A, glutamine; B, fermentable fiber; C, peptide diet; and D, standard enteral formula with fibers combined with Synbiotic 2000 (Synbiotic 2000 Forte; Medifarm, Sweden), a formula containing live lactobacilli and specific bioactive fibers. Intestinal permeability was evaluated by measuring lactulose‐mannitol excretion ratio on days 2, 4, and 7. Results: No differences in days of mechanical ventilation, intensive care unit stay, or multiple‐organ failure scores were found between the patient groups. A total of 51 infections, including 38 pneumonia, were observed, with only 5 infections and 4 pneumonias in group D, which was significantly less than combined infections ( p = .003) and pneumonias ( p = .03) in groups A, B, and C. Intestinal permeability decreased only in group D, from 0.148 (0.056–0.240) on day 4 to 0.061 (0.040–0.099) on day 7; ( p < .05). In group A, the lactulose‐mannitol excretion ratio increased significantly ( p < .02) from 0.050 (0.013–0.116) on day 2 to 0.159 (0.088–0.311) on day 7. The total gastric retention volume in 7 days was 1150 (785–2395) mL in group D, which was significantly more than the 410 (382–1062) mL in group A ( p < .02), and 620 (337–1190) mL in group C ( p < .03). Conclusions: Patients supplemented with synbiotics did better than the others, with lower intestinal permeability and fewer infections.