INFLUENCE OF ARGININE, OMEGA-3-FATTY-ACIDS AND NUCLEOTIDE-SUPPLEMENTED ENTERAL SUPPORT ON SYSTEMIC INFLAMMATORY RESPONSE SYNDROME AND MULTIPLE ORGAN FAILURE IN PATIENTS AFTER SEVERE TRAUMA

This study investigated the influence of an enteral diet supplemented with arginine, omega-3 fatty acids, and nucleotides (Impact, Sandoz Nu trition, Berne, Switzerland) on the incidence of systemic inflammatory response syndrome (SIRS) and multiple organ failure (MOF) in patients after severe trauma. Thirty-two patients with an injury-severity scor e >20 were included in this prospective, randomized, double-blind, con trolled study. Primary endpoints were the incidence of SIRS and MOF. S econdary endpoints were parameters of acute phase and immune response as well as infection rate, mortality, and hospital stay. For statistic al analysis 29 patients (test group n = 16, control n = 13) were eligi ble. In the test group, significantly fewer SIRS days per patient were found during 28 d. The difference was highly significant between d 8- 14 (P < 0.001). MOF score was significantly lower in the test group on d 3 and d 8-11 (P < 0.05). Acute phase parameters showed lower C-reac tive protein serum levels (significant on D day 4) and fibrinogen plas ma levels (significant on d 12 and 14; P < 0.05). HLA-DR expression on monocytes showed significantly higher fluorescence activity on d 7. N o significant difference was found for T-lymphocyte CD4/CD8 ratio, int erleukin-2 receptor expression, infection rate, mortality (2/16 vs. 4/ 13), and hospital stay. The results of the study provide further suppo rt for beneficial effects of arginine, omega-3-fatty acids and nucleot ide-supplemented enteral diet in critically ill patients. (C)Elsevier Science Inc. 1998.