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1.
Article in English | IMSEAR | ID: sea-137672

ABSTRACT

Some studies of the protein metabolism in severely injured patients with sepsis are reported. Knowledge of changes in blood amino acid levels will improve patient management. A prospective study was performed in severely injured patients (ISS 20-40) admitted to ICU as trauma cases, at Siriraj Hospital between January 1993 and December 1994. Ten patients were involved : five non-sepsis patients and five sepsis patients. Blood samples were drawn for determining amino acids levels on the first day of injury, then 7 and day 14. Blood samples were also obtained from three normal non-trauma volunteers as the control group. After injury, amino acids levels increased, in most of the patients, especially serine and lysine which significantly increased, both in non-sepsis groups. Only the especially serine and lysine which significantly decreased in the non-sepsis group at day 14. The branched chain amino acids (valine, leucine, isoleucine) increases more than the aromatic amino acids (phenylalanine, tyrosine, tryptophan). Glutamic acid, for the functional maintenance of mucosal cells of the intestine, and arginine, the immune supporter, were found to have increased in the sepsis group.

2.
Article in English | IMSEAR | ID: sea-44297

ABSTRACT

To evaluate the nutritional, metabolic and immune effects of dietary arginine, glutamine and omega-3 fatty acids (fish oil) supplementation in immunocompromised patients, we performed a prospective study on the effect of immune formula administered to 11 severe trauma patients (average ISS = 24), 10 burn patients (average % TBSA = 48) and 5 cancer patients. Daily calorie and protein administration were based on the patient's severity (Stress factor with the range of 35-50 kcal/kg/day and 1.5-2.5 g/kg/day, respectively) Starting with half concentration liquid immune formula through nasogastric tube by continuous drip at 30 ml/h and increasing to maximum level within 4 days. The additional energy and protein requirement will be given either by parenteral or oral nutritional support. Various nutritional, metabolic, immunologic and clinical parameters were observed on day 0 (baseline), day 3, 7, and 14. Analysis was performed by paired student-t test. Initial mean serum albumin and transferrin showed mild (trauma) to moderate (burn and cancer) degree of malnutrition. Significant improvement of nutritional parameters was seen at day 7 and 14 in trauma and burn patients. Significant increase of total lymphocyte count (day 7, P < 0.01), CD4 + count (day 7, p < 0.01), CD8 + count (day 7, p < 0.0005 & day 14, p < 0.05), complement C3 (day 7, p < 0.005 day 14, p < 0.01), IgG (day 7, and 14, p < 0.0005), IgA (day 7, p < 0.0005 & day 14, p < 0.05), in all patients. C-reactive protein decreased significantly on day 7 (p < 0.0005) and day 14 (p < 0.005). 3 cases of burn wound infection, one case of UTI and one case of sepsis were observed. Two cases of hyperglycemia in burn, 3 cases of hyperbilirubinemia in trauma, 10 cases of elevated LFT (5 trauma/5 burn), and one case of hyponatremia in cancer patients were observed. Two cases of nausea, 4 cases of vomiting, 5 cases of diarrhea (< 3 times/day), 2 cases of abdominal cramp, 1 case of distension were observed. The feeding of IMMUNE FORMULA was well tolerated and significant improvement was observed in nutritional and immunologic parameters as in other immunoenhancing diets. Further clinical trials of prospective double-blind randomized design are necessary to address the so that the necessity of using immunonutrition in critically ill patients will be clarified.


Subject(s)
Adult , Arginine/administration & dosage , Burns/physiopathology , CD4-CD8 Ratio , Dietary Supplements , Enteral Nutrition , Fatty Acids, Omega-3/administration & dosage , Female , Glutamine/administration & dosage , Humans , Immunocompromised Host/physiology , Immunoglobulins/blood , Lymphocyte Count , Male , Middle Aged , Neoplasms/physiopathology , Nutritional Status , Phenotype , Prospective Studies , Treatment Outcome , Wounds and Injuries/physiopathology
3.
Article in English | IMSEAR | ID: sea-38530

ABSTRACT

Multiple trauma is associated with altered metabolism, wasting of the lean body mass and compromised wound healing. Nutritional support is one way to improve the condition of these critically ill patients. We performed a prospective randomized study on the effect of early nutritional support in severely injured patients admitted to the Division of Traumatic Surgery, Siriraj Hospital between June 1992 and January 1994. Thirty-eight severe traumatic patients with ISS between 20-40 were randomly divided into control and study group. The 17 patients in the control group were treated in the conventional method with administration of hypo caloric intravenous regimen and supplement with oral diet as soon as the bowel function was returned. The 21 patients of the study group were fed either by enteral or parenteral feeding or both with an appropriate caloric and protein requirement as soon as hemodynamic status was stabilized. We found the study group had a lower mortality rate, a lower complication rate, a shorter period of ICU stay, and an earlier weaning from the ventilator than the control group. The study group also lost less weight than the control group. Nitrogen balance in the study group was significantly lower than the control group.


Subject(s)
Adult , Enteral Nutrition/methods , Female , Humans , Male , Multiple Trauma/mortality , Nutritional Support/methods , Parenteral Nutrition/methods , Prospective Studies , Severity of Illness Index , Survival Rate , Time Factors , Treatment Outcome
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