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1.
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
2.
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
3.
Article in English | IMSEAR | ID: sea-138095

ABSTRACT

Sixteen severely burned patients, divided into four groups according to the extent of their burns, were studied while being fed a special diet used as a supplemental nutritional support. The first group of two patients comprised those with burns covering less than 20 percent of the body surface area (BSA). The second group of six patients comprised those with burns covering 21-40 percent BSA. The third group of six patients had burns covering 41-60 percent BSA, and the fourth group of two patients had burns more than 60 percent BSA. The special diet for burn patients was given as a supplemental diet between meals or with meals to fulfil each patient’s demand for calories and protein. Enteral feeding was started as soon as the gastrointestinal function could be tolerated. We found that the special diet for burn patients raised the positive nitrogen balance in all group and kept weight loss to a minimum. For those burned extensively, particularly those with burns exceeding 40 percent BSA, some from of parenteral nutrition was needed as a secondary supplemental diet. Serum albumin gradually rose to the normal levels tended to be slightly elevated. Unfortunately, we have not been able to follow the changes in body chemistry after the patients were discharged from the hospital.

4.
Article in English | IMSEAR | ID: sea-38121

ABSTRACT

To investigate the effectiveness of a new electrolyte solution, Glucolyte-2, which contains 7.5 per cent glucose, electrolytes, and a trace element (zinc), 12 postoperative surgical and 21 trauma patients who were unable to receive enteral feeding were given either Glucolyte-2 or the conventional infusion containing 5 per cent glucose and electrolytes as a control in a double-blind fashion. The zinc balance in surgical patients given Glucolyte-2 was 2.648 +/- 864 micrograms/day, whereas that in patients given the conventional infusion was -2,972 +/- 1,385 micrograms/day (mean +/- S.E.M.). The positive zinc balance after Glucolyte-2 administration was significantly higher than that after the conventional infusion (p less than 0.001). Similarly, a positive zinc balance (3,464 +/- 422 micrograms/day) was obtained in trauma patients given Glucolyte-2, while in trauma patients given the conventional infusion, the zinc balance was negative (-1,737 +/- 491 micrograms/day), which was significantly lower (p less than 0.05). Magnesium and phosphate balances were negative in surgical and trauma patients in both infusion groups. However, the balance in patients given Glucolyte-2 was better than in those patients given the conventional infusion. The differences of the balance for magnesium in surgical patients and trauma patients were significant (p less than 0.001 and p less than 0.01, respectively). The differences of the balance for phosphate in surgical and trauma patients were also significant (p less than 0.01). It is indicated that the infusion of Glucolyte-2 containing zinc and other electrolytes will be more favorable than the conventional infusion in both surgical and trauma patients.


Subject(s)
Adolescent , Adult , Aged , Double-Blind Method , Electrolytes/blood , Fluid Therapy/methods , Glucose/therapeutic use , Humans , Infusions, Intravenous/methods , Isotonic Solutions , Male , Middle Aged , Postoperative Care/methods , Wounds and Injuries/therapy
5.
Article in English | IMSEAR | ID: sea-138246

ABSTRACT

Five hundreds and sixty-one patients hospitalized in Siriraj Hospital during the period from August – December 1988 were evaluated for their nutritional status. There were 349 surgical patients and 212 medical patients; 332 female and 229 males. Based on anthropometric parameters, the status of protein calorie-malnutrition was found to be 33.4% by weight-height, 33.9% by sum skinfold thickness, 28.1% by proportion of baby fat, and 9.7% by mid-arm muscle circumference. Abnormal caloric status was more prevalent than their protein status. Obesity was detected in 41.1, 40 and 11.1%, and overnutrition 7.5, 11.9 and 13.2%, according to sum skinfold thickness, proportion of body fat and weight-height, respectively. There were 35.4, 3.8 and 12.2% patients who had haemoglobin, serum protein and albumin levels below the occeptable range. The present study in this group of patients disclosed not only undernutrition but also overnutrition.

6.
Article in English | IMSEAR | ID: sea-138485

ABSTRACT

Necrotizing fasciitis is not uncommon at the present time, mostly occurring in patients with minor extremity injury as the common predisposing factors. Aetiological agents in our 35 reported cases were usually β haemolytic streptococcus, although many infections were the mixed type and associated with gram negative bacillus or gram positive coccus. All were treated by wide surgical opening of the lesion and extensive surgical debridement. The large doses of penicillin were parenterally given along with aminoglycosides to all patients. Local wound treatment was daily applied with silver zine sulfadiazine which appeared to be the most suitable topical agent because not only arresting the infective process but also stimulating the new granulation tissue. Wound closure in all 35 patients were achieved within the appropriate time, averaging 2 weeks. No most important factor in the treatment of necrotizing fasciitis is the early diagnosis and early adequate surgical debridement.

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