Effects of early enteral nutrition on intestinal permeability and the development of multiple organ failure after multiple injury.
OBJECTIVE
To determine how immediate enteral nutrition (EN) affects gut permeability and the development of multiple organ failure (MOF) in multiply injured patients.


METHODS
Prospective, randomised clinical trial.


METHODS
20-bed surgical intensive care unit (ICU), university hospital.


METHODS
28 consecutive multiply injured patients, admitted in shock and stabilised in 6 h.


METHODS
Patients were randomly assigned to EN started not later than 6 h after admission to the ICU (group A), and to EN started later than 24 h after admission (group B).


RESULTS
The lactulose/mannitol (L/M) test was performed in patients on days 2 and 4 after trauma, and in 5 healthy volunteers. MOF scores were calculated daily. The mean MOF score from day 4 onwards was 1.84 in group A versus 2.81 in group B (p < 0.002), and was correlated with the time of initiation of EN after injury and the L/M ratio on day 2. The median L/M ratio on day 2 was 0.029 for group A and 0.045 for group B, while on day 4 it was 0.020 and 0.060, respectively. On day 2 after trauma, the L/M ratio was significantly higher in group B (p < 0.05) than in normal volunteers (median 0.014) and was positively correlated with the time of starting EN.


CONCLUSIONS
In contrast with normal volunteers, the patients started on EN later than 24 h after admission to the ICU demonstrated increased intestinal permeability on the second day after sustaining multiple injury. Also, they had a more severe form of MOF than the group placed on EN immediately upon admission. However, early EN had no influence on the length of ICU stay or the time of mechanical ventilation.
Kompan
L
L
University Clinical Centre Ljubljana, CIT, Slovenia. lidija.kompan@bfro.uni-lj.si
Kremzar
B
B
Gadzijev
E
E
Prosek
M
M
D000328:Adult; D000704:Analysis of Variance; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007413:Intestinal Mucosa / Q000378:metabolism*; D007792:Lactulose / Q000097:blood; D008297:Male; D008353:Mannitol / Q000097:blood; D009102:Multiple Organ Failure / Q000145:classification / Q000209:etiology*; D009104:Multiple Trauma / Q000145:classification / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D010539:Permeability; D012121:Respiration, Artificial; D013997:Time Factors
D008353:Mannitol; D007792:Lactulose