Synbiotics, prebiotics, glutamine, or peptide in early enteral nutrition: a randomized study in trauma patients

JPEN J Parenter Enteral Nutr. Mar-Apr 2007;31(2):119-26. doi: 10.1177/0148607107031002119.

Abstract

Background: Since the hepatosplanchnic region plays a central role in development of multiple-organ failure and infections in critically ill trauma patients, this study focuses on the influence of glutamine, peptide, and synbiotics on intestinal permeability and clinical outcome.

Methods: One hundred thirteen multiple injured patients were prospectively randomized into 4 groups: group A, glutamine; B, fermentable fiber; C, peptide diet; and D, standard enteral formula with fibers combined with Synbiotic 2000 (Synbiotic 2000 Forte; Medifarm, Sweden), a formula containing live lactobacilli and specific bioactive fibers. Intestinal permeability was evaluated by measuring lactulose-mannitol excretion ratio on days 2, 4, and 7.

Results: No differences in days of mechanical ventilation, intensive care unit stay, or multiple-organ failure scores were found between the patient groups. A total of 51 infections, including 38 pneumonia, were observed, with only 5 infections and 4 pneumonias in group D, which was significantly less than combined infections (p = .003) and pneumonias (p = .03) in groups A, B, and C. Intestinal permeability decreased only in group D, from 0.148 (0.056-0.240) on day 4 to 0.061 (0.040-0.099) on day 7; (p < .05). In group A, the lactulose-mannitol excretion ratio increased significantly (p < .02) from 0.050 (0.013-0.116) on day 2 to 0.159 (0.088-0.311) on day 7. The total gastric retention volume in 7 days was 1150 (785-2395) mL in group D, which was significantly more than the 410 (382-1062) mL in group A (p < .02), and 620 (337-1190) mL in group C (p < .03).

Conclusions: Patients supplemented with synbiotics did better than the others, with lower intestinal permeability and fewer infections.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • APACHE
  • Adult
  • Aged
  • Dietary Fiber / administration & dosage
  • Enteral Nutrition*
  • Female
  • Glutamine / therapeutic use*
  • Humans
  • Infections / epidemiology*
  • Injury Severity Score
  • Intestinal Mucosa / metabolism
  • Male
  • Middle Aged
  • Multiple Organ Failure / etiology
  • Multiple Organ Failure / prevention & control
  • Multiple Trauma / mortality
  • Multiple Trauma / therapy*
  • Permeability
  • Probiotics / therapeutic use*
  • Prospective Studies
  • Time Factors
  • Treatment Outcome

Substances

  • Dietary Fiber
  • Glutamine