Synbiotics, prebiotics, glutamine, or peptide in early enteral nutrition: a randomized study in trauma patients.
BACKGROUND
Since the hepatosplanchnic region plays a central role in development of multiple-organ failure and infections in critically ill trauma patients, this study focuses on the influence of glutamine, peptide, and synbiotics on intestinal permeability and clinical outcome.


METHODS
One hundred thirteen multiple injured patients were prospectively randomized into 4 groups: group A, glutamine; B, fermentable fiber; C, peptide diet; and D, standard enteral formula with fibers combined with Synbiotic 2000 (Synbiotic 2000 Forte; Medifarm, Sweden), a formula containing live lactobacilli and specific bioactive fibers. Intestinal permeability was evaluated by measuring lactulose-mannitol excretion ratio on days 2, 4, and 7.


RESULTS
No differences in days of mechanical ventilation, intensive care unit stay, or multiple-organ failure scores were found between the patient groups. A total of 51 infections, including 38 pneumonia, were observed, with only 5 infections and 4 pneumonias in group D, which was significantly less than combined infections (p = .003) and pneumonias (p = .03) in groups A, B, and C. Intestinal permeability decreased only in group D, from 0.148 (0.056-0.240) on day 4 to 0.061 (0.040-0.099) on day 7; (p < .05). In group A, the lactulose-mannitol excretion ratio increased significantly (p < .02) from 0.050 (0.013-0.116) on day 2 to 0.159 (0.088-0.311) on day 7. The total gastric retention volume in 7 days was 1150 (785-2395) mL in group D, which was significantly more than the 410 (382-1062) mL in group A (p < .02), and 620 (337-1190) mL in group C (p < .03).


CONCLUSIONS
Patients supplemented with synbiotics did better than the others, with lower intestinal permeability and fewer infections.
Spindler-Vesel
Alenka
A
University Medical Centre, Ljubljana, Slovenia.
Bengmark
Stig
S
Vovk
Irena
I
Cerovic
Ognjen
O
Kompan
Lidija
L
D018806:APACHE; D000328:Adult; D000368:Aged; D004043:Dietary Fiber / Q000008:administration & dosage; D004750:Enteral Nutrition; D005260:Female; D005973:Glutamine / Q000627:therapeutic use*; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D015601:Injury Severity Score; D007413:Intestinal Mucosa / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000517:prevention & control; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy*; D010539:Permeability; D019936:Probiotics / Q000627:therapeutic use*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D004043:Dietary Fiber; D005973:Glutamine