Comparison of a Immunonutrition Formula Enriched Arginine, Glutamine and Omega-3 Fatty Acidt, with a Currently High-Enriched Enteral Nutritiontt for Trauma Patients
CHOMCHARK CHUNTRASAKUL, MD*, SORANIT SILTHAM, MD*, SUTTIPANT SARASOMBATH, MD**, CHOCKCHAI SITTAPAIROCHANA, MD***, WATTANAS LEOWATTANA, MD***, SIRIYA CHOCKVIVA TA NA V ANIT, RN*, AROONRASAMEE BUNNAK, RN*
Affiliation : * Research Center for Nutrition Support, ** Department of Immunology, *** Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. t Neomune® tt Traumacal
Method : To evaluate the metabolic and immune effects of dietary arginine, glutamine and omega-3 fatty acids (fish oil) supplementation, we performed a prospective study in patients age 15-60 yrs after severe trauma (Injury Severity Scores (ISS) 15-30) or bum patients (body surface area (BSA) 30-60%) in Siriraj Hospital. They were randomized to receive either Neomune or Traumacal. The naso gastric feeding was started in post-injury day 2 (PID2) with half of concentration at the rate of 30 ml/h. From PID3 to PID 10, the normal concentration was administered at the rate of 80-100 ml/h depending on optimal caloric requirement. All patients received 5 per cent dextrose in half or full strength saline solution as clinically indicated. No other oral nutrients apart from study formula were allowed during the study. Blood sample was with-drawn on PID2, PID6 and PID11 for measurements of CBC, coagulo gram, albumin, transferrin, CRP, LFT, BUN, Cr, CD , CD , CD , CD , C , lgG, lgM, and lgA. Nitrogen 3 19 4 8 3 balance was calculated from UUN. Unpaired student t-test was applied to compare variables between the two groups.
Results : 36 patients were selected (16 trauma and 20 bum), male= 29, mean age= 29.86 yrs. The patients were divided equally into two groups to receive Neomune or Traumacal. The data were com pared and showed significance on total protein on PID11 (Neomune = 6.52 ± 1.29, Traumacal = 5.59 ± 1.21, p = 0.03) and serum triglycerides on PID11 (Neomune = 128.39 ± 53.45, Traumacal = 186.25 ± 84.07, p = 0.02). The ICU stay was observed shorter in Neomune than in Traumacal group (3.41 and 7.83 days) with no statistical significance. The wean-off respirator day was also shorter in Neomune than in Traumacal group (2.71 and 7.39 days). One patient in each group died.
Conclusions : The feeding of Neomune in critically injured patients was well tolerated as Traumacal and significant improvement was observed in serum protein. Shorten ICU stay and wean-off respirator day may benefit from using the immunonutrient formula.
Keywords : Immunonutrition, Arginine, Glutamine Omega-3 Fatty Acid, Trauma, Bum
