The effect of a low volume pharmaconutrition supplement with antioxidants and glutamine (Intestamine®) administration to critically ill patients on the prevalence of infection, ventilation requirements and duration of intensive care unit stay : a pilot study

[摘要] ENGLISH ABSTRACT: IntroductionComplications of severe infection or acute trauma include a cascade ofimmunological dysfunctions known as SIRS (Systemic Inflammatory ResponseSyndrome), that affect response to treatment, prolonging and complicating thecourse of illness and jeopardizing clinical outcome. Timing and the nature ofnutritional support in the Intensive Care Unit (ICU) setting may influence thisprocess. Against this background, and despite some trials demonstratingbeneficial clinical outcomes for the use of immune-modulating diets (IMD), thefindings of the US summit on immune-enhancing enteral therapy concluded thatthe currently available enteral immune-enhancing formulas are 'first-generationproducts which may not be appropriate in patients with SIRS or severe sepsis.This highlights a need for alternative nutritional products that target the specificneeds of this patient population. As such, Intestamin® is designed for use inseverely stressed patients as an immune-modulating enteral feed supplementwhich aims to improve maintenance of gut barrier integrity and immuneresponse.AimThe aim of this pilot study was to investigate the effect of Intestamin®administration to critically ill patients, and in particular, to determine ifadministration would impact on nosocomial infections, ventilation days and thelength of stay in the ICU.MethodsThe study design was an open label, retrospective case control, analytical study,of patients admitted to the ICU in The Bay Hospital, Richards Bay, betweenJanuary 2002 and November 2003, who received Intestamin®. Patients wereselected for the study from post-surgery and post-trauma patients at high risk ofsepsis and SIRS, and critically ill patients with manifested SIRS or severe sepsis.Development of respiratory and urinary sepsis was used as surrogate markersfor progression to severe sepsis and SIRS. Additionally, duration of ventilation and ICU stay were considered representative of the response to treatment anddegree of clinical complications.ResultsThe findings of the study demonstrated a significant difference in the rates ofrespiratory infection(p=0.05), positive sputum and tracheal aspiratecultures(p=0.03) and urinary catheter tip cultures(p=0.04). with statistically lowerrates in the intervention group compared to the control group. There were nosignificant differences in the rates of urinary tract infection, septicaemia or incombined sepsis rates between the two groups. There were statisticallysignificant higher rates of positive pus cell counts in the sputum(p=0.003) andurine(p=0.01) in the intervention group, compared to the control group. Nocorresponding reduction in ventilation days or ICU stay was observed.ConclusionIn this patient population, early enteral nutrition with specially formulated IMD,(Intestamin®), did result in a significant reduction in respiratory infections, but notin other types of sepsis, ICU or ventilator days in critically ill ICU patients. Thispositive finding in some, but not all endpoints collected, may reflect confoundingfactors in the small patient population or the choice of clinical endpoints, ratherthan a genuine limitation in the benefit. IMD remains a tantalizing andscientifically plausible intervention in this patient population, with larger clinicaltrials necessary to confirm outcomes. The study supports the safe use ofIntestamin by the nasojejenal route in this patient population.

[发布机构] Stellenbosch University