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Clinical Trial
. 1998 Jan;26(1):24-30.
doi: 10.1097/00003246-199801000-00012.

Artificial nutrition after major abdominal surgery: impact of route of administration and composition of the diet

Affiliations
Clinical Trial

Artificial nutrition after major abdominal surgery: impact of route of administration and composition of the diet

M Braga et al. Crit Care Med. 1998 Jan.

Abstract

Objective: To evaluate the impact of the route of administration of artificial nutrition and the composition of the diet on outcome.

Design: Prospective, randomized, clinical trial.

Setting: Department of surgery, university hospital.

Patients: One hundred sixty-six consecutive patients undergoing curative surgery for gastric or pancreatic cancer.

Interventions: At operation, the patients were randomized into three groups to receive: a) a standard enteral formula (control group; n = 55); b) the same enteral formula enriched with arginine, RNA, and omega-3 fatty acids (enriched group; n = 55); and c) total parenteral nutrition (TPN group; n = 56). The three regimens were isocaloric and isonitrogenous. Enteral nutrition was started within 12 hrs following surgery. The infusion rate was progressively increased to reach the nutritional goal (25 kcal/kg/day) on postoperative day 4.

Measurements and main results: Tolerance of enteral feeding, rate and severity of postoperative complications, and length of hospital stay were recorded. Early enteral infusion was well tolerated. Side effects were recorded in 22.7% of the patients, but only 6.3% did not reach the nutritional goal. The enriched group had a lower severity of infection than the parenteral group (4.0 vs. 8.6; p < .05). In subgroups of malnourished (n = 78) and homologous transfused patients (n = 42), the administration of the enriched formula significantly reduced both severity of infection and length of stay compared with the parenteral group (p < .05). Moreover, in transfused patients, the rate of septic complications was 20.0% in the enriched group, 38.4% in the control group, and 42.8% in the TPN group.

Conclusions: Early enteral feeding is a suitable alternative to TPN after major abdominal surgery. The use of the enriched diet appears to be more beneficial in malnourished and transfused patients.

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Comment in

  • Death knell for parenteral nutrition?
    Nelson LD. Nelson LD. Crit Care Med. 1998 Jan;26(1):4. doi: 10.1097/00003246-199801000-00003. Crit Care Med. 1998. PMID: 9428530 No abstract available.
  • Intensive care unit support formulations.
    Boullata JI. Boullata JI. Crit Care Med. 1999 Feb;27(2):441-3. doi: 10.1097/00003246-199902000-00060. Crit Care Med. 1999. PMID: 10075077 No abstract available.
  • Possible duplicate publication.
    Lipman TO. Lipman TO. Crit Care Med. 1999 Jul;27(7):1402-3. doi: 10.1097/00003246-199907000-00052. Crit Care Med. 1999. PMID: 10446850 No abstract available.

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