title: Immunonutrition - the influence of early postoperative glutamine supplementation in enteral/parenteral nutrition on immune response, wound healing and length of hospital stay in multiple trauma patients and patients after extensive surgery.
abstract: BACKGROUND
  In the postoperative phase, the prognosis of multiple trauma patients with severe brain injuries as well as of patients with extensive head and neck surgery mainly depends on protein metabolism and the prevention of septic complications. Wound healing problems can also result in markedly longer stays in the intensive care unit and general wards. As a result, the immunostimulation of patients in the postoperative phase is expected to improve their immunological and overall health.
  
  
  METHODS
  A study involving 15 patients with extensive ENT tumour surgery and 7 multiple-trauma patients investigated the effect of enteral glutamine supplementation on immune induction, wound healing and length of hospital stay. Half of the patients received a glutamine-supplemented diet. The control group received an isocaloric, isonitrogenous diet.
  
  
  RESULTS
  In summary, we found that total lymphocyte counts, the percentage of activated CD4+DR+ T helper lymphocytes, the in-vitro response of lymphocytes to mitogens, as well as IL-2 plasma levels normalised faster in patients who received glutamine-supplemented diets than in patients who received isocaloric, isonitrogenous diets and that these parameters were even above normal by the end of the second postoperative week.
  
  
  CONCLUSIONS
  We believe that providing critically ill patients with a demand-oriented immunostimulating diet is fully justified as it reduces septic complications, accelerates wound healing, and shortens the length of ICU (intensive care unit) and general ward stays.
authors.affiliation: Bundeswehr Hospital of Ulm, Department of Otolaryngology, Head and Neck Surgery, Ulm, Germany.
authors.forename: Kai J
authors.initials: KJ
authors.lastname: Lorenz
authors.affiliation: Bundeswehr Hospital of Ulm, Surgical Centre, Department of Accident Surgery and Orthopaedics, Ulm, Germany.
authors.forename: Reiner
authors.initials: R
authors.lastname: Schallert
authors.affiliation: University of Heidelberg, Institute of Transplantation Immunology, Heidelberg, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Daniel