Effects of early enteral arginine supplementation on resuscitation of severe burn patients.
OBJECTIVE
To investigate the effects of dietary supplementation of l-arginine (l-Arg) on shock in severely burned patients.


METHODS
This was a prospective, randomized, single blind, controlled study. Forty-seven severely burned patients due to various causes with a total burn surface area (TBSA) more than 50% each admitted in early postburn phase (within 10h postburn) were included in this study. All patients were treated by the traditional resuscitation program of our institute. After the nasogastric feeding tube was placed, they were randomly divided into three groups-(1) group A400 (n = 16): giving gastrointestinal feeding with 500 ml 5% GNS, containing l-Arg (400 mg/ kgday) at equal pace with fluid resuscitation; (2) group A200 (n = 16): giving gastrointestinal feeding with 500 ml 5% GNS containing l-Arg (200 mg/ kgday); (3) group C (n = 15): giving gastrointestinal feeding with 500 ml 5% GNS without any supplementation. The feeding started within 12h after burn and lasted for 72 h, the feeding rate was controlled by an enteral feeding pump. The following parameters were observed on days (PBD) 1-4: serum nitric oxide content (NO), mean arterial blood pressure (MAP), oxygenation index (PO2/FiO2), and arterial blood content of lactic acid (LA). Gastric mucosal blood flow was measured by laser Doppler flow-metry on PBD1 and PBD2.


RESULTS
(1) Enteral feeding of l-Arg did not change MAP of severely burned patients, with no difference in MAP between the l-Arg supplemented and control groups. (2) There were significant changes of the l-Arg supplemented groups (A400 and A200), with an increased gastric mucosa blood flow, oxygenation index, and a decreased LA content in arterial blood, compared with the control group. (3) The serous NO content was significantly decreased in the A400 group on PBD2-4 (P < 0.01), and in the A200 group on PBD4 (P < 0.05) compared with the control group.


CONCLUSIONS
Enteral feeding with l-arginine supplementation on early stage of burn decreases NO production to a relatively normal level and exerts beneficial effects on the resuscitation of burned shock.
Yan
Hong
H
Institute of Burn Research, Southwest Hospital, The Third Military Medical University, State Key Laboratory of Trauma, Burns, and Combined Injury (SKLTBC), Chongqing 400038, PR China. yrandy@tom.com
Peng
Xi
X
Huang
Yuesheng
Y
Zhao
Mingyue
M
Li
Fangyong
F
Wang
Pei
P
D000293:Adolescent; D000328:Adult; D001120:Arginine / Q000008:administration & dosage*; D001794:Blood Pressure / Q000502:physiology; D002056:Burns / Q000097:blood / Q000178:diet therapy* / Q000503:physiopathology; D019587:Dietary Supplements; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods; D012769:Shock / Q000097:blood / Q000178:diet therapy* / Q000503:physiopathology; D016037:Single-Blind Method
D009569:Nitric Oxide; D019344:Lactic Acid; D001120:Arginine; D010100:Oxygen