NUTRITIONAL AND IMMUNE EFFECTS OF EARLY ENTERAL FEEDING SUPPLEMENTED BY ARGININE, GLUTAMINE AND OMEGA 3 FATTY ACID IN CRITICALLY ILL PATIENTS
ABSTRACT: This study was
performed to evaluate nutrition, immune cell respond and clinical outcomes of
early enteral feeding enriched with arginine, glutamine and omega 3 fatty
acid. Material and method: Study design:
Preliminary prospective, one center. Twenty eligible ICU patients were involved
to this study by consecutive sampling from March 2003 - September 2004, age
between 25-65 years, no previous
infection, APACHE II score 10 -15. They were randomized to receive either
standard or immune enhancing formula enriched with glutamine, arginine, omega 3
fatty acids, and high protein. Formula was given with the concentration 0.5
kcal/cc on the day one and increased to meet the target calories 25-30
kcal/kg/day and 1 - 1.5 g protein/kg/day. The laboratory measurement was made
on the day one and seventh. Beside the routine measurement prealbumin and
transferrin level were measured as nutritional indicator, total lymphocytes
count, CD4 and CD8 cell count were used as immune function indicators. Major
complication, mortality, aspiration and GI adverse reaction were observed.
Results: The standard group received more calories (33.3 kcal/kg/day) and less
protein (0.98g/kg/day) compared to immune enhancing group which received less
calories b (24.9 kcal/kg/day) but more protein (1.51 g/kg/day). Prealbumin
significantly increased in the treatment group, but no difference in ICU length
of stay and ventilator days. The ICU mortality is higher in standard subgroup
which use ventilator more than 1 week, compared to the same subgroup in immune
enhancing group (3/10 vs 0/10). All of deaths were caused by severe pneumonia.
Statistically, there was no significant change of TLC and CD4, CD8 cell count in both groups, but
there was an inclination tendency of CD4 count and declination tendency of CD8
count in immune enhancing group. The two formulas were tolerated well since
only one diarrhea in standard group. Conclusion: Early enteral feeding with
immune enhancing in critically ill
scored APACHE II 10-15 have beneficial effects for clinical outcome, nutrition
and immune cell response as well.
Keywords: immune cell
response, nutritional and clinical outcome, immune enhancing early enteral
feeding, critically ill patients
Author: Nancy Margarita
Rehatta
Journal Code: jpkedokterangg050032
