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TEN versus TPN following major abdominal trauma--reduced septic morbidity
Insights
Early enteral feeding (TEN) in critically injured patients improved resistance to infection and reduced septic complications compared to parenteral nutrition (TPN). TEN was well-tolerated, showing better nutritional marker restoration and fewer infections.
Area of Science:
- Critical care medicine
- Surgical nutrition
- Trauma management
Background:
- Animal models suggest enteral nutrition (TEN) enhances infection resistance over parenteral nutrition (TPN).
- The impact of early nutritional support on critically injured patients remains a key area of research.
Purpose of the Study:
- To compare the effects of early TEN versus TPN on infection resistance and septic complications in critically injured patients.
- To evaluate the tolerance and efficacy of jejunal feeding in severe trauma.
Main Methods:
- Prospective clinical trial randomizing 75 critically injured patients (ATI 15-40) to early TEN or TPN within 12 hours post-op.
- Both groups received specialized nutritional regimens with a 150:1 calorie to nitrogen ratio.
- TEN was delivered via needle catheter jejunostomy; TPN used standard solutions.
Main Results:
- Jejunal feeding was well-tolerated in 86% of the TEN group.
- Nitrogen balance was similar between groups (Day 5: TEN -0.3 +/- 1.0 vs. TPN 0.1 +/- 0.8 gm/day).
- Improved restoration of albumin, transferrin, and retinol-binding protein was observed in the TEN group.
- Infections occurred in 17% of TEN patients vs. 37% of TPN patients.
- Major septic morbidity was significantly lower in the TEN group (3%) compared to the TPN group (20%).
Conclusions:
- Early enteral nutrition is well-tolerated and safe for severely injured patients.
- Initiating feeding via the gut early in critically injured patients significantly reduces septic complications.
- Enteral feeding may offer superior outcomes in managing infection and morbidity in trauma patients compared to parenteral nutrition.
Abstract:
Recent animal models suggest that enteral feeding (TEN) compared to parenteral nutrition (TPN) improves resistance to infection. This prospective clinical trial examined the impact of early TEN vs. TPN in the critically injured. Seventy-five patients with an abdominal trauma index (ATI) greater than 15 and less than 40 were randomized at initial laparotomy to receive either TEN (Vivonex TEN) or TPN (Freamine HBC 6.9% and Trophamine 6%); both regimens contained 2.5% fat, 33% branched chain amino acids, and had a calorie to nitrogen ratio of 150:1. TEN was delivered via a needle catheter jejunostomy. Nutritional support was initiated within 12 hours postoperatively in both groups, and infused at a rate sufficient to render the patients in positive nitrogen balance. The study groups (TEN = 29 vs TPN = 30) were comparable in age, injury severity and initial metabolic stress. Jejunal feeding was tolerated unconditionally in 25 (86%) of the TEN group. Nitrogen balance remained equivalent throughout the study period, at day 5 TEN = -0.3 +/- 1.0 vs. TPN 0.1 +/- 0.8 gm/day. Traditional nutritional protein markers (albumin, transferrin, and retinol binding protein) were restored better in the TEN group. Infections developed in 5 (17%) of the TEN patients compared to 11 (37%) of the TPN group. The incidence of major septic morbidity was 3% (1 = abdominal abscess) in the TEN group contrasted to 20% (2 = abdominal abscess, 6 = pneumonia) with TPN. This clinical study demonstrates that TEN is well tolerated in the severely injured, and that early feeding via the gut reduces septic complications in the stressed patient.