COMPARISON OF SPECIALIZED AND STANDARD ENTERAL FORMULAS IN TRAUMA PATIENTS

Study Objective. To compare selected nutrition and immunologic markers and infection in trauma patients receiving a specialized enteral form ula with those receiving standard enteral therapy Design. Prospective, randomized clinical trial. Setting. Level 1 trauma center at a county government hospital. Patients. Forty-one consecutive patients with ma jor trauma who required enteral nutrition support. Thirty-seven patien ts completed the study. Four patients (two in each group) were exclude d, as additional operative procedures prevented initiation of enteral feedings within 7 days of injury Interventions. Nineteen patients fed the specialized enteral formula received supplemental arginine, linole nic acid, beta-carotene, and hydrolyzed protein for up to 10 days. Eig hteen control patients received standard enteral nutrition. Measuremen ts and Main Results. After study entry, patients who received the spec ialized enteral formula had fewer infections than those receiving stan dard enteral nutrition (3/19 vs 10/18; p<0.05). The change in nitrogen balance was significantly better (p<0.05) from day 1 (-11.8 +/- 1.8 g /day) to day 5 (-5.9 +/- 2.0 g/day) for the group who received the spe cialized formula compared with the group who received standard enteral nutrition (-7.3 +/- 1.7 g/day to -7.4 +/- 2.8 g/day). Similarly, the change in C-reactive protein serum concentration was significantly bet ter (p<0.05) from day 1 (18.0 +/- 2.1 mg/dl) to day 5 (11.8 +/- 1.5 mg /dl) in the group who received the specialized formula compared with t he group who received standard enteral nutrition (17.6 +/- 1.2 mg/dl t o 14.4 +/- 1.7 mg/dl). The CD4:CD8 ratio increased more in the group w ho received the specialized formula, although this difference did not reach statistical significance. Conclusion. Trauma patients who receiv ed the specialized enteral formula demonstrated a decreased incidence of infection and increased improvements in nitrogen balance and other indexes of stress. Additional clinical trials demonstrating positive p atient outcomes are necessary before these specialized enteral formula s are used as the standard of practice in critically ill patients.