A prospective, randomized trial of intravenous fat emulsion administration in trauma victims requiring total parenteral nutrition.
OBJECTIVE
Intravenous fat infusions are a standard component of total parenteral nutrition (TPN). We studied the effects of withholding fat infusions in trauma patients requiring TPN.


METHODS
Polytrauma patients receiving TPN were randomized to receive a standard fat emulsion dose (L) or to have fat infusions withheld (NL) for the first 10 days of TPN. The two groups received the same amino acid and carbohydrate dose (isonitrogenous, nonisocaloric).


METHODS
Clinical outcome parameters were measured. T-cell function was assessed by measuring lymphokine activated killer and natural killer cell activity.


RESULTS
Demographics including Injury Severity Score (27 +/- 8; 30 +/- 9) and APACHE II scores (23 +/- 6; 22 +/- 5) were similar for the L (n = 30) and NL (n = 27) groups, respectively. Differences (p < 0.05) were found in length of hospitalization (L = 39 +/- 24; NL = 27 +/- 16), intensive care unit length of stay (L = 29 +/- 22; NL = 18 +/- 12), and days on mechanical ventilation (L = 27 +/- 21; NL = 15 +/- 12). The L group had a higher number of infections (72 in 30) than the NL group (39 in 27) and T-cell function was depressed in this group.


CONCLUSIONS
Intravenous fat emulsion infusions during the early postinjury period increased susceptibility to infection, prolonged pulmonary failure, and delayed recovery in critically injured patients. It is not clear whether the improved outcome in the NL group was directly related to withholding the fat infusions or due to the hypocaloric nutritional regimen (underfeeding) these patients received.
Battistella
F D
FD
Department of Surgery, University of California, Davis, Medical Center, Sacramento 95817-2282, USA.
Widergren
J T
JT
Anderson
J T
JT
Siepler
J K
JK
Weber
J C
JC
MacColl
K
K
D018806:APACHE; D000293:Adolescent; D000328:Adult; D015232:Dinoprostone / Q000378:metabolism; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology / Q000276:immunology; D015601:Injury Severity Score; D007362:Intensive Care Units; D015979:Killer Cells, Lymphokine-Activated / Q000276:immunology; D007694:Killer Cells, Natural / Q000276:immunology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000628:therapy*; D010289:Parenteral Nutrition, Total; D011446:Prospective Studies; D016896:Treatment Outcome
D005217:Fat Emulsions, Intravenous; D015232:Dinoprostone