Effects of enteral immunonutrition supplemented with omega-3 polyunsaturated fatty acid on the inci-dences of ventilator associated pneumonia complications in patients with severe traumatic brain injury undergoing ventilator therapy / 中华临床营养杂志

ABSTRACT

Objective To investigate the effects of enteral immunonutrition supplemented with omega-3 polyunsaturated fatty acid (ω-3 PUFA) on the incidences and severity of ventilator associated pneumonia com- plications, inflammatory response, and the prognosis in patients with severe traumatic brain injury (sTBI) un-dergoing ventilator therapy. Methods From January 2015 to June 2017, 64 patients of sTBI were selected and randomly divided into experimental group (ω-3 PUFA, n=32) and control group (n=32). White blood cells (WBC) and the proportion of neutrophils (N%) were evaluated by cell analyzer. Meanwhile, the serum levels of C-reactive protein (CRP) and procalcitonin (PCT) were tested with enzyme linked immunosorbent assay. After 14-days treatment, the Glasgow coma scale (GCS) score, APACHE Ⅱ score, clinical pulmonary infec-tion score (CPIS), pulmonary function and prognoses were also compared between the two groups. Results As compared with the control group, the experimental group had lower incidences of ventilator associated pneumonia (66% vs. 56%, P=0. 048), reduced degree of lung infection and lower CPIS (8. 25±0. 60 vs. 7. 47±0. 53); higher lung function indexes [FVC (2. 89±0. 19) L vs. (3. 46±0. 22) L, P=0. 010;FEV1 (2. 35±0. 16) L vs. (2. 84±0. 24) L, P=0. 040; FEV1/FVC % (49. 11±3. 34)% vs. (56. 00± 2. 64)%, P=0. 038) ]; lower serum levels of inflammatory responses [WBC (11. 83±0. 74) ×109/L vs. (9. 51±0. 90) ×109/L, P=0. 029; N% (79. 11±1. 51)% vs. (72. 71±1. 16)%, P=0. 041; CRP(85. 15±8. 42) mg/L vs. (63. 96±5. 72) mg/L, P=0. 001; PCT (6. 43±0. 47) μg/L vs. (4. 83±0. 39) μg/L, P=0. 013] 14 days after enteral immunonutrition supplemented with ω-3 PUFA. As compared with the control group, the experimental group received better prognosis with GCS scores increasing ( 8. 69 ± 0. 41 vs. 9. 52±0. 59, P=0. 038), APACHE Ⅱ scores decreasing (14. 74±1. 01 vs. 12. 68±0. 89, P=0. 049), the time of mechanical ventilation [ (13. 23±1. 17) d vs. (10. 88±1. 24) d, P=0. 024] and the hospitalization days [ (23. 29±2. 45) d vs. (18. 42±1. 96) d, P=0. 012] reduced on the 14th day, mechanical ventilation withdraw rate within 14 days increasing [24/32 (75%) vs. 27/32 (84%), P=0. 030] on the 14th day. Conclusion Enteral immunonutrition supplemented with ω-3 PUFA can effectively reduce the incidence of ventilator associated pneumonia, alleviate the degree of infection and the inflammatory response in patients with sTBI undergoing ventilator therapy possibly improving condition and prognosis, which is worthy of being widely used.