title: Randomized trial to evaluate nutritional status and absorption of enteral feeding after brain death.
abstract: BACKGROUND
  Catecholamines and inflammatory mediators, with elevated levels after brain death, are associated with reduced function and survival of transplanted organs. Enteral nutrition reduces tissue damage and may benefit organs.
  
  
  OBJECTIVE
  To evaluate the effects of immunomodulating enteral nutrition in organ donors.
  
  
  METHODS
  Prospective, randomized, open-label study.
  
  
  METHODS
  Intensive care unit.
  
  
  METHODS
  Thirty-six brain-dead organ donors.
  
  
  METHODS
  Donors were randomized to receive enteral nutrition containing omega-3 polyunsaturated fatty acid, antioxidants, and glutamine or standard care (fasting). Donors received hormonal replacement therapy of corticosteroid, levothyroxine, dextrose, and insulin.
  
  
  METHODS
  Gastrointestinal assimilation (measured by 13 carbon-labeled uracil breath analysis), quantity of organs recovered, resting energy expenditure, urine level of urea nitrogen, and serum levels of albumin, prealbumin, interleukin 6, tumor necrosis factor-α, and C-reactive protein were evaluated.
  
  
  RESULTS
  Thirteen patients (36%) assimilated 13C-labeled uracil. Resting energy expenditure was significantly higher than predicted between 10 and 14 hours after baseline in 33 donors (P= .007). Other measures were not conclusively different between fed and fasting groups. No adverse events occurred that were related to the enteral feeding.
  
  
  CONCLUSIONS
  About 30% of donors metabolized 13C-labeled uracil, although no difference in oxidation rate was found between fasting and fed donors. Corticosteroid administration lowers plasma levels of interleukin 6 and most likely contributes to greater than predicted resting energy expenditure. Thus energy needs may not be met during fasting if hormones are given. Consequences of this possible energy deficit warrant further study.
authors: The University of Texas at Houston Memorial Hermann Hospital-Texas Medical Center, Houston.
authors: Georgene W
authors: GW
authors: Hergenroeder
authors: Norman H
authors: NH
authors: Ward
authors: Xiaoying
authors: X
authors: Yu
authors: Antone
authors: A
authors: Opekun
authors: Anthony N
authors: AN
authors: Moore
authors: Claudia A
authors: CA
authors: Kozinetz
authors: David J
authors: DJ
authors: Powner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001926:Brain Death / Q000276:immunology*; D004734:Energy Metabolism; D004750:Enteral Nutrition; D005260:Female; D006085:Graft Survival; D006801:Humans; D056747:Immunomodulation; D007249:Inflammation / Q000517:prevention & control*; D007408:Intestinal Absorption; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D020858:Tissue and Organ Harvesting