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Comparison of specialized and standard enteral formulas in trauma patients
R O Brown1, H Hunt, C A Mowatt-Larssen
1Department of Clinical Pharmacy, University of Tennessee, Memphis 38163.
Study Objective:
To compare selected nutrition and immunologic markers and infection in trauma patients receiving a specialized enteral formula with those receiving standard enteral therapy.
Design:
Prospective, randomized clinical trial.
Setting:
Level 1 trauma center at a county government hospital.
Patients:
Forty-one consecutive patients with major trauma who required enteral nutrition support. Thirty-seven patients completed the study. Four patients (two in each group) were excluded, as additional operative procedures prevented initiation of enteral feedings within 7 days of injury.
Interventions:
Nineteen patients fed the specialized enteral formula received supplemental arginine, linolenic acid, beta-carotene, and hydrolyzed protein for up to 10 days. Eighteen control patients received standard enteral nutrition.
Measurements And Main Results:
After study entry, patients who received the specialized enteral formula had fewer infections than those receiving standard enteral nutrition (3/19 vs 10/18; p < 0.05). The change in nitrogen balance was significantly better (p < 0.05) from day 1 (-11.8 +/- 1.8 g/day) to day 5 (-5.9 +/- 2.0 g/day) for the group who received the specialized formula compared with the group who received standard enteral nutrition (-7.3 +/- 1.7 g/day to -7.4 +/- 2.8 g/day). Similarly, the change in C-reactive protein serum concentration was significantly better (p < 0.05) from day 1 (18.0 +/- 2.1 mg/dl) to day 5 (11.8 +/- 1.5 mg/dl) in the group who received the specialized formula compared with the group who received standard enteral nutrition (17.6 +/- 1.2 mg/dl to 14.4 +/- 1.7 mg/dl). The CD4:CD8 ratio increased more in the group who received the specialized formula, although this difference did not reach statistical significance.
Conclusion:
Trauma patients who received the specialized enteral formula demonstrated a decreased incidence of infection and increased improvements in nitrogen balance and other indexes of stress. Additional clinical trials demonstrating positive patient outcomes are necessary before these specialized enteral formulas are used as the standard of practice in critically ill patients.