Exocrine pancreas disfunction in severely traumatised patients and early enteral nutrition

We investigated exocrine pancreatic insufficiency in severely traumatised patients with enteral nutrition using the fecal elastase-1 concentration.

The fecal elastase-1 levels of critically ill patients after major trauma (n=18) were determined in a prospective study. Early enteral nutrition was started with a high molecular diet via a naso-duodenal tube, starting 24-36 hours after admission to the intensive care unit. Enteral feeding was administered continuously starting with 20 mL/h (1 kcal/mL) and advanced gradually to 80 mL/h in the next days. Stool samples from the first and second stool after beginning of the enteral nutrition were taken for determination of the fecal elastase-1. For elastase-1 analysis in a sandwich-type enzyme immunoassay (ELISA), a sample of approximately 1 g stool was taken from the first and second stool after beginning of the enteral nutrition. Elastase-1 concentration of >200 microg/g was considered as normal, whereas <100 microg/g elastase-1 was significantly low indicating a severe exocrine pancreas dysfunction.

All patients were fed enterally without relevant feeding-associated complications and no diarrhoea occurred in any patient. In the initial stool passage, 55.6% of the patients had moderately or severely decreased elastase-1 concentrations. In the second stool passage, only 38.9% of the patients showed a decrease in the elastase-1 concentration (p<0.01). The average elastase-concentration in the first stool sample was 268.4 microg/g (median: 162.1 microg/g) and in the second sample 333.8 microg/g (median: 520.2 microg/g).

The data of this study suggests that initial exocrine pancreas insufficiency may occur in severely traumatised and critically ill patients, which improves under early enteral nutrition with polymeric enteral diets. The clinical consequences of exocrine pancreatic dysfunction in the early posttraumatic situation have to be defined.