Decreased mortality and infectious morbidity in adult burn patients with enteral glutamine supplements

S78

the extent of inflammation and pancreatic necrosis. Early administartion of n-3 polyunsaturated fatty acids (PUFA) might have antiinflammatory effects trough modulation on eicosanoid synthesis. Method: In a prospective, randomized clinical trial 14 patients (pts) with AP received n-3 PUFAs enterally (3.3 g/day for 5-7 days), in a fom of oil (Phama Nord), 14 pts were in control group. Measurement of antioxidant status (Superoxide-dismutase activity, Total Antioxidant Status, Vitamin A, E), serum C-reactive protein, prealbumin and standxd examinations were performed at admission, day 3, 7 and 14, fatty acids determination at admission and day 7 of jejunal feeding (JF). Results: Plasma docosahexaenoic acid values significantly increased, whereas xachidonic acid values significantly decreased as on effect of supplementation (e. q. triacyl glycerols: 2,lS (1,76) vs. 2,56 (2,69) and 14,03(9,53) vs. 11,67(6,36) % by wt, median (IQR)). Supplementation I-esuited in significant decrease in lenght of hospitalisation (13,7+5,31 vs 19,2+7,18days, p 0,05) and JF (10,4+4,68 vs 15,6+6,4, p 0,05). In n-3 PUFA treated group 604 of pts (42%), in controls 904 (64%) had complications. There wele no significant difference between two groups in antioxidants and acute phase reactants. Conclusions: Supplementation of enteral formula with n-3 PUFAs in AP seems to have clinical benefits. O m results xe promising concerning the administration of n-3 PUFAs in the treatment of AP.

289-O. SKELETAL FLUOROSIS: AN UNUSUAL METABOLIC BONE COMPLICATION IN HPN PATIENTS .I. Reimund’, N. Afif’, A. Ledit’, D. Hercelin’, .I. Sibilia’, B. Duclos’, R. Baumann t ‘H pato-Gastroent rologie et Assistance Nutritive, 2Rhumatologie, H pitaun Universitaires de Strasbourg, H pita1 de Hautepierre, Strasbourg Ceden, France Rationale: Prevalence and pathophysiology of HPN-associated metabolic bone disease (MBD) xe patially unknown. Therefore, we began a systematic review of 0~1’patients in order to increase our knowledge in this paticular field. Here, we report two cases of skeletal fluorosis, an unusual HPN-related bone abnormality. Method: Until now, 12 patients (6 men, 6 women), aged 55f16 (MfSD), on HPN for 42f27 months (12-144) have been assessed. Clinical symptoms were recorded and laboratory pxameters including makers of bone metabolism, hormonal and nutritional status, radiologic studies and measurement of bone mineral density (BMD) by dual absorptiometly wele performed. If needed bone biopsy was done. Results: Ten patients had low BMD (median cortical T-score: -2.3, range: -5.4 to -1.6) ; median trabecular T-score: -2.8, range: -3 to -0.8). In 2 men aged 80 and 68 (HPN since 12 and 7 years), with a history of back pain, diffuse bone condensation on radiologic studies and high bone tunover on biochemical analysis, trabecular BMD was increased at +4.06 and +4X9. Biopsy confilms osteomalacia and revealed an increased fluoride content (1.04 and 0.49%, N: O.lf0.07%). Aluminium content was normal. In one patient fluoride was not only provided by trace elements solutions but also by an important consumption of mineral water containing high fluoride levels (78 g over 12 years). Conclusions: Most HPN patients exhibit MBD, more often osteopenia or osteoporosis than osteomalacia. Fluoride deficiency has been suggested to be responsible for decreased BMD in HPN patients. By contrast, the present work gives evidence for possible fluoride toxicity in other HPN patients. In these patients IV trace elements may not be the sole source of fluoride, and therefore, clinicians should be cxefull about their patients oral fluoride intake.

EUROPEAN

SOCIETY

OF PARENTERAL

AND

ENTERAL

NUTRlTION

290-O. DECREASED MORTALITY AND INFECTIOUS MORBIDITY IN ADULT BURN PATIENTS W ITH ENTERAL GLUTAMINE SUPPLEMENTS D.R. Garrel’, J. Bernie? ‘Endocrinology, H tel.Dieu du CHUM, Montreal, 21mmunology, INRS-Sant , Pointe-Claire, Canada Rationale: Enteral glutamine (G) supplements have been shown to reduce infectious morbidity in trauma patients, but their effect on bum patients is not known. Method: The objective of this double-blinded, randomized clinical trial was to measure the impact of enteral G supplementation on infectious morbidity, length of care (LOC) and the immune system in bun patients. Forty-five adult subjects with severe buns were randomized to receive either G or an isonitrogenous control mixture (C) until complete healing ocumed. LOC, the incidence of positive blood culture (PBC), and mortality were recorded. Phagocytosis by circulating polymorphonuclear cells (PMN) was measured every 3 days. Results: Patient chxacteristics were similar in both groups. F o m patients were excluded from the analysis, as 3 of them died within 72 h and the fourth could not receive enteral nutrition and amino acid supplements for the first 10 days. Of the remaining 41 patients, LOC in the survivors was not different between groups (0.9 vs 1.0 days/% total body surface xea for G vs C, respectively), PBC was 3 times more frequent in C than in G (4.3 vs 1.2 days/patient, p’ 0.05), and Pseudomonas aeruginosa was detected in 6 patients on C and 0 on G (p 5 0.05). Phagocytosis by PMN was not different between groups. Mortality was significantly lower in G than in C: intention to treat: 2 vs 12 (p 5 0.05); per protocol analysis: 0 vs 8 (p 5 0.01). Conclusions: Enteral glutamine supplementation in adult bun patients I-educes blood infection by a factor of 3, prevents bacteremia with P. aeruginosa, and may decrease mortality. It has no effect on LOC, and does not appear to influence phagocytosis by circulating PMN.

291-P. EFFECTS O F LIPID BASED NUTRITION ON CLINICAL OUTCOME O F PATIENTS AFTER SEVERE TRAUMA G. Huschak, K. Z m Nieden, R. Stuttmann Department of Anaesthesiology, Bergmannstrost Hospital, Halle, Germany Rationale: Major changes in the metabolism of trauma patients are increased lipid oxidation, hyperglycaemia and insulin resistance. The metabolic and clinical effects of nutrition regimens with different Lipid/ Glucose (L/G) calorie ratios were investigated. Method: 30 trauma victims (ISS > 15) were randomised to receive either a lipid based nutrition (group L) with L/G ratio = 75/25 or a standard regimen (group G) with L/G ratio = 37,5/62,5 of non protein calories in a combined pxenteral-enteral regimen. Group L received an olive/soybean emulsion (ClinOleic 20%) to avoid undesirable effects of high intake of polyunsaturated fatty acids. In group G a soybean emulsion (Lipofundin 20% N) was infused. The daily caloric demand was determined by indirect calorimetry. Results: Both nutritional regimes increased the serum triglyceride values (TG) without differences between the groups. L revealed a significant I-eduction of blood glucose levels (BG), respiratory minute volumes (MV), days of mechanical ventilation and days of intensive exe. Table

1 Group

L

Group

G

p-Value

TG (mgldl)

203,6 zk 14,4

1X6,0 zk 12,O

0,36a

BG (mmol/l)

7,2X zk 0,46

x,73 * 0,45

0,03a

97,3 *

11,o

129,9 & 6,7

0,02a

13,X & 2,3

20,4 zk 1,X

19,5 * 2,x

25,l

MV

(mllmin

RESPIRATOR

per kg body

weigh)

DAYS

ICU DAYS values

as mean & SEM;

a Student’s

t-Test;

b Mann-Whitney

*

1,x

0,03a 0,045b

U-Test

Conclusions: Main advantages of the lipid based regimen were the reduction of mechanical ventilation and days of intensive exe. The reduction of BG and general superior effects of lipids as the main energy fuel instead of