A RANDOMIZED TRIAL OF ISONITROGENOUS ENTERAL DIETS AFTER SEVERE TRAUMA - AN IMMUNE-ENHANCING DIET REDUCES SEPTIC COMPLICATIONS

Objective The authors randomized patients to an enteral diet containin g glutamine, arginine, omega-3 fatty acids, and nucleotides or to an i sonitrogenous, isocaloric diet to investigate the effect of septic out come. A third group of patients, without enteral access but eligible b y severity of injury, served as unfed controls and were studied prospe ctively to determine the risk of infection. Summary Background Data La boratory and clinical studies suggest that diets containing specialty nutrients, such as arginine, glutamine, nucleotides, and omega-3 fatty acids, reduce septic complications. Unfortunately, most clinical tria ls have not compared these diets Versus isonitrogenous, isocaloric con trols. This prospective, blinded study randomized 35 severely injured patients with an Abdominal Trauma Index greater than or equal to 25 or a Injury Severity Score greater than or equal to 21 who had early ent eral access to an immune-enhancing diet ([IED] Immun-Aid, McGaw, Inc., Irvine, CA; n = 17) or an isonitrogenous, isocaloric diet (Promote [R oss Laboratories, Columbus, OH] and Casec [Mead-Johnson Nutritionals, Evansville, [N]; n = 18) diet. Patients without early enteral access b ut eligible by severity of injury served as contemporaneous controls ( n = 19). Patients were evaluated for septic complications, antibiotic usage, hospital and intensive care unit (CU) stay, and hospital costs. Results Two patients died in the treatment group and were dropped fro m the study. Significantly fewer major infectious complications (6%) d eveloped in patients randomized to the IED than patients in the isonit rogenous group (41%, p = 0.02) or the control group (58%, p = 0.002). Hospital stay, therapeutic antibiotics, and the development of intra-a bdominal abscess was significantly lower in patients receiving the IED than the other two groups. This improved clinical outcome was reflect ed in reduced hospital costs. Conclusions An IED significantly reduces major infectious complications in severely injured patients compared with those receiving isonitrogenous diet or no early enteral nutrition . An IED is the preferred diet for early enteral feeding after severe blunt and penetrating trauma in patients at risk of subsequent septic complications. Unfed patients have the highest complication rate.