[Effects of various feeding regimens in multiple trauma patients on septic complications and immune parameters].
OBJECTIVE
The aim of this study was to investigate the incidence of septic complications, the immunological changes by the course of lymphocyte subsets and metabolic parameters on polytraumatised patients when given nutritional support in form of early enteral and total parenteral nutrition. Furthermore, we looked for differences between a standard enteral diet and a diet supplemented with arginine, omega-3-fatty acids, nucleotide, and selenium.


METHODS
30 polytraumatised patients with an Acute Physiology and Chronic Health Evaluation II (APACHE II)-Score > 10 points, who received nutritional support for a minimum of 7 days, were randomised to a "supplemented enteral group" (group 1), an "enteral standard group" (group 2), or a "parenteral group" (group 3). In the first both groups there were early enteral feeding. The patients of group 3 were fed isonitrogenous and isocaloric to group 2. Leucocytes, lymphocytes, CD3(+)-, CD4(+)-, CD3+HLA-DR(+)-, CD8(+)-, CD19(+)-subsets, natural killer-cells (CD56+) and metabolic parameters were measured on days 1, 3, 5, 7.


RESULTS
Septic complications occurred in 2 patients in group 1, in 1 patient in group 2 and in 4 patients in group 3. The total number of lymphocytes had an increase on day 7 in group 1 (1420/microliter) and group 2 (1620/microliter) and were higher compared with group 3 (1044/microliter). On day 7 T-cells (CD3+) were 1107/microliter in group 1, 1014/microliter in group 2 and 770/microliter in group 3, T-helper-cells (CD4+) rose on day 7 higher in the enteral fed groups (group 1:746/microliter, group 2:719/microliter) than in group 3 (570/microliter). No significant differences between the groups were seen by CD3+HLA-DR(+)-cells, T-suppressor-cells (CD8+), B-cells (CD19+) and natural killer-cells (CD56).


CONCLUSIONS
Early enteral nutrition seems to stabilise the immunosuppression of polytraumatised patients in an earlier phase. There is a consolidation of the lymphocyte counts, and of T(CD3+)- and T-helper-cells (CD4+). This could be the immunological correlate for the number of septic complications in the enteral fed groups. Therefore polytraumatised patients should be fed rather early enteral than parenteral when possible. In the initial phase after the trauma the way of nutritional support has more importance on the immune system as nutritional contents. So, in this form of studying, there is no advantage of immunonutrition.
Engel
J M
JM
Abteilung Anästhesiologie und Operative Intensivmedizin Justus-Liebig-Universität Giessen.
Menges
T
T
Neuhäuser
C
C
Schaefer
B
B
Hempelmann
G
G
D018806:APACHE; D000328:Adult; D003422:Critical Care; D004750:Enteral Nutrition; D005260:Female; D005526:Food, Formulated; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000276:immunology / Q000628:therapy*; D009753:Nutritive Value; D010289:Parenteral Nutrition, Total; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000276:immunology*; D016176:T-Lymphocyte Subsets / Q000276:immunology; D016896:Treatment Outcome