[Randomized study of two different fat emulsions in total parenteral nutrition of malnourished surgical patients;effect of infectious morbidity and mortality]. / Estudio aleatorio de dos emulsiones grasas diferentes en la nutrición parenteral total del enfermo quirúrgico desnutrido: efecto sobre la morbilidad infecciosa y la mortalidad.

GOAL: Lipid infusions of a physical mixture of medium-chain triglycerides and long-chain triglycerides (MCT/LCT) used in peri-operative total parenteral nutrition (TPN) have a lower immunosuppressive effect in laboratory studies than emulsions containing only long-chain triglycerides (LCT). The purpose of the present study was to compare the incidence of nosocomial infections and the in-hospital mortality of severely undernourished surgical patients treated with TPN using an MCT/LCT lipid emulsion or with an LCT mixture, administered under a randomized, double blind protocol. PATIENTS AND METHODS: A total of 72 severely undernourished patients subjected to planned or emergency laparotomy were prospectively recruited and stratified by the presence or absence of cancer, on admission to the departments of General Surgery and Intensive Care Medicine at a teaching hospital. The main outcome was the incidence of intra-hospital nosocomial infection and the secondary outcome was mortality. RESULTS: The patients in the study group (MCT/LCT) and the control group (LCT) shared similar characteristics. The patients in the MCT/LCT group had a significantly lower incidence of intra- abdominal abscesses (2/26) than those in the LCT group (10/31) (p < 0.05; RR 0.18; CI 95%; 0.03-0.89). There were no significant differences in the incidence of other infections. Nor was there a difference between the two groups in terms of the intra-hospital mortality (4/26 versus 11/31). In the stratified analysis, patients without cancer treated with MCT/LCT presented significantly fewer intra-abdominal abscesses (2/14) than those with LCT (5/8) (p < 0.05; RR 0.1; CI 95%; 0.01-0.79) and a significantly lower mortality (2/14 versus 5/8; p < 0.05; RR 0.1; CI 95%; 0.01-0.79). CONCLUSIONS: Lipid infusions of MCT/LCT used in peri-operative TPN protect severely undernourished surgical patients against the onset of intra-abdominal abscesses when compared with LCT infusions. Patients without cancer may obtain more benefit from the use of these mixtures.

Estudio aleatorio de dos emulsiones grasas diferentes en la nutrición parenteral total del enfermo quirúrgico desnutrido: efecto sobre la morbilidad infecciosa y la mortalidad / Randomized study of two different fat emulsions in total parenteral nutrition of malnourished surgical patients: effect on infectious morbidity and mortality

Objetivo: Las infusiones lipídicas de una mezcla física de triglicéridos de cadena media/triglicéridos de cadena larga (MCT/LCT), utilizadas en la nutrición parenteral total (NPT) peroperatoria, tienen menos efecto inmunosupresor en estudios de laboratorio que las emulsiones que contienen únicamente triglicéridos de cadena larga (LCT). El objetivo de este estudio fue comparar la incidencia de infecciones nosocomiales y la mortalidad hospitalaria de los pacientes quirúrgicos severamente desnutridos, tratados con NPT con una emulsión lipídica de MCT/LCT, o con una mezcla LCT, administradas de forma aleatoria y a doble ciego. Pacientes y métodos: Se reclutaron de forma prospectiva 72 pacientes severamente desnutridos sometidos a una laparotomía programada o urgente, estratificados por la presencia o ausencia de cáncer, e ingresados en los Servicios de Cirugía General y Medicina Intensiva de un hospital universitario. El desenlace principal fue la incidencia de infección nosocomial intrahospitalaria y el desenlace secundario fue la mortalidad. Resultados: Los pacientes del grupo de estudio (MCT/LCT) y el grupo control (LCT) tenían características similares. Los pacientes del grupo de MCT/LCT tuvieron una menor incidencia de abscesos intraabdominales (2/26) que el grupo LCT (10/31) de forma significativa (p < 0,05; RR 0,18; IC 95 por ciento: 0,03-0,89). No hubo diferencias significativas en la incidencia de otras infecciones. Tampoco fue diferente la mortalidad intrahospitalaria entre ambos grupos (4/26 frente a 11/31). En el análisis estratificado, los pacientes sin cáncer tratados con MCT/LCT presentaron menos abscesos intraabdominales (2/14) que los tratados con LCT (5/8) de forma significativa (p < 0,05; RR 0,1; IC 95 por ciento: 0,01-0,79) y una menor mortalidad (2/14 frente a 5/8; p < 0,05; RR 0,1; IC 95 por ciento: 0,01-0,79).Conclusiones: Las infusiones lipídicas de MCT/LCT, utilizadas en la NPT peroperatoria, protegen de la aparición de abscesos intraabdominales en los pacientes quirúrgicos severamente desnutridos en comparación con las infusiones de LCT. Los pacientes sin cáncer pueden verse más beneficiados del uso de estas mezclas (AU)

Goal: Lipid infusions of a physical mixture of medium- chain triglycerides and long-chain triglycerides (MCT/LCT) used in peri-operative total parenteral nutrition (TPN) have a lower immunosuppressive effect in laboratory studies than emulsions containing only longchain triglycerides (LCT). The purpose of the present study was to compare the incidence of nosocomial infections and the in-hospital mortality of severely undernourished surgical patients treated with TPN using an MCT/LCT lipid emulsion or with an LCT mixture, administered under a randomized, double blind protocol. Patients and methods: A total of 72 severely undernourished patients subjected to planned or emergency laparotomy were prospectively recruited and stratified by the presence or absence of cancer, on admission to the departments of General Surgery and Intensive Care Medicine at a teaching hospital. The main outcome was the incidence of intra-hospital nosocomial infection and the secondary outcome was mortality. Results: The patients in the study group (MCT/LCT) and the control group (LCT) shared similar characteristics. The patients in the MCT/LCT group had a significantly lower incidence of intra- abdominal abscesses (2/26) than those in the LCT group (10/31) (p < 0.05; RR 0.18; CI 95%; 0.03-0.89). There were no significant differences in the incidence of other infections. Nor was there a difference between the two groups in terms of the intrahospital mortality (4/26 versus 11/31). In the stratified analysis, patients without cancer treated with MCT/LCT presented significantly fewer intra-abdominal abscesses (2/14) than those with LCT (5/8) (p < 0.05; RR 0.1; CI 95%; 0.01-0.79) and a significantly lower mortality (2/14 versus 5/8; p < 0.05; RR 0.1; CI 95%; 0.01-0.79). Conclusions: Lipid infusions of MCT/LCT used in perioperative TPN protect severely undernourished surgical patients against the onset of intra-abdominal abscesses when compared with LCT infusions. Patients without cancer may obtain more benefit from the use of these mixtures (AU)