PP017-SUN GLUTAMINE GRANULES-SUPPLEMENTED ENTERAL NUTRITION MAINTAIN IMMUNOLOGICAL FUNCTION IN THE SEVERE BURNED PATIENTS

PP017-SUN GLUTAMINE GRANULES-SUPPLEMENTED ENTERAL NUTRITION MAINTAIN IMMUNOLOGICAL FUNCTION IN THE SEVERE BURNED PATIENTS

Critical Care of d4 protein and energy target achieved on 28d mortality (adjusted for each other), with additional adjustments for sex, BMI, APACHE II...

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Critical Care of d4 protein and energy target achieved on 28d mortality (adjusted for each other), with additional adjustments for sex, BMI, APACHE II score, and diagnosis category. Results: 871 patients were included, with half the patients (394) meeting energy target. 28d mortality was 18.6%; and mortality was higher when energy target was met (21.0% vs 15.7%, p = 0.029). Within this group meeting energy target, meeting also protein target was beneficial with lower 28d mortality (18.9% vs 27.9%, p = 0.046). Without meeting energy target also protein target was not met and could not be analysed. The Hazard Ratio for 28d mortality when meeting protein target was 0.64 (95% CI 0.43 0.96, p = 0.030; adjusted 0.64, 0.43 0.96, p = 0.032) and when meeting energy target 1.77 (1.17 2.68, p = 0.007; adjusted 1.63, 1.08 2.48, p = 0.021). Conclusion: In this cohort of ventilated patients, a higher early protein delivery of more than 1.2 g/kg was associated with a lower 28d mortality. In contrast, high early energy delivery related to higher mortality. References Weijs PJ, Stapel SN, de Groot SD, et al. JPEN J Parenter Enteral Nutr. 2012 Jan; 36(1): 60 8. Disclosure of Interest: None Declared

PP015-SUN EARLY PERMISSIVE ENTERAL UNDERFEEDING IN CRITICALLY ILL HEAD TRAUMA PATIENTS: A DOUBLE BLIND RANDOMIZED CONTROLLED TRIAL A. Norouzy1 , M. Kazemi1 , F. Samini2 , M. Nematy3 . 1 Nutrition Department, 2 Neurosurgery Department, Mashad University of Medical Sciences, 3 Nutrition Department, Mashad University of Medical Scieces, Mashad, Iran, Islamic Republic Of Rationale: The optimal amount of energy to provide the nutritional support for critically ill patients still remains controversial. The aim of this study was to examine the clinical and metabolic outcomes of permissive underfeeding versus standard (full calorie) feeding in critically ill patients with head trauma in early days of hospitalization. Methods: Sixty adult patients with head trauma randomly assigned to a double-blind randomized controlled clinical trial. Enteral tube feeding was administered to either standard feeding (full calorie) or permissive underfeeding groups (initiation caloric goal: 90 100% vs. 30 50% of calculated requirement, respectively). Patients in the latter group were prescribed to achieve 100% of energy requirements until day 7 of intervention and thereafter. Results: The primary outcome was 28 day all-cause mortality of %3.8 in the standard feeding vs. 10.7% in the permissive underfeeding group (RR: 0.33; 95% CI: 0.03, 3.42; P = 0.61). Standard feeding group had trends towards more NPO (nil per osse) days due to elevated gastric residual volumes and diarrhea (1.1±1 vs. 0.6±1, P = 0.06) and significantly higher episodes of gastrointestinal intolerance (5.2±3 vs. 1.4±2, P < 0.001) of feeding days; Liver enzymes, AST (62.3±37 vs. 122.5±76 IU/L, P = 0.03) and ALT (47.7±35 vs. 88.7±57 IU/L, P = 0.04) were lower in the permissive underfeeding group in the first 7 days of feeding. The incidence of hyperglycemia (205.6±68 vs. 137.4±59 mg/dL, P = 0.02), length of hospital stay (35.6±25 vs. 19.9±11 days, P = 0.03) and mechanical

S27 ventilation duration (17.9±21 vs. 4.7±4 days, P = 0.03) were higher in the standard feeding group. Conclusion: Permissive underfeeding may be associated with improved metabolic and gastrointestinal tolerance and reduced length of hospital stay. Disclosure of Interest: None Declared

PP016-SUN NUTRITION DURING SURGERY INCREASES MYOCARDIAL ARGININE/ADMA RATIO AND ESSENTIAL AMINO ACIDS IN PATIENTS UNDERGOING OFF-PUMP CORONARY ARTERY BYPASS GRAFTING: A RANDOMIZED CONTROLLED TRIAL M. Visser1,2 , B.A. de Mol2 , P.A. van Leeuwen1 . 1 Surgery, VU University Medical Center, 2 Cardiothoracic Surgery, Academic Medical Center University of Amsterdam, Amsterdam, Netherlands Rationale: Nitric oxide (NO) is essential for proper cardiovascular functioning but might be low in the surgical patient as its precursor arginine decreases and the NO synthase inhibitor asymmetric dimethylarginine (ADMA) increases in these patients resulting in a low arginine/ADMA ratio. Besides arginine, several amino acids are essential for proper cardiovascular metabolism. We investigated whether supplementation of (par) enteral nutrition during surgery can increase myocardial arginine/ADMA ratio and amino acids. Methods: In 33 patients undergoing off-pump coronary artery bypass grafting, enteral, parenteral or no nutrition (control) was supplemented from two days before, during, until two days after surgery. A myocardial tissue sample was taken before and after revascularization, and analysed for arginine/ADMA ratio, and amino acids concentrations. Results: During surgery the increases in myocardial arginine/ADMA ratio, branched chain amino acids (BCAA) and essential amino acids (EAA) concentrations were significantly higher in the enteral and parenteral group compared to the control group (arginine/ADMA ratio: 47.7 (30.7 74.9), 49.6 (33.0 68.0), and 26.0 (15.4 32.5), p = 0.012; BCAA (nmol/g tissue): 12.6 (7.1 27.1), 14.9 (6.6 23.6), and 1.0 ( 1.8 9.2), p = 0.029; EAA (nmol/g tissue): 15.2 (7.4 39.2), 26.8 (3.4 48.2), and 4.1 ( 11.9 11.7) p = 0.040). Conclusion: Enteral or parenteral nutrition during surgery can increase the arginine/ADMA ratio, and BCAA and EAA concentrations in the human heart. Disclosure of Interest: None Declared

PP017-SUN GLUTAMINE GRANULES-SUPPLEMENTED ENTERAL NUTRITION MAINTAIN IMMUNOLOGICAL FUNCTION IN THE SEVERE BURNED PATIENTS X. Peng1 , Y. Sun1 . 1 State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burns of PLA, Southwest Hospital, Third Military Medical University, Chongqing, China Rationale: To observe the effects of enteral nutrition supplemented glutamine granules on immunological function in severe burned patients. Methods: 48 severe burn patients( total burn surface area 30 75%, full thickness burn area 20 58% ) who met the requirements of the protocol joined this double-blind randomized controlled clinical trail. Patients were randomly divided

S28 into two groups: burn control group (B group, 23 patients) and glutamine treated group (Gln group, 25 patients). Gln and B group patents had been supplemented glutamine granules or placebo (glycine) at 0.5 g/kg·d for 14 days with oral feeding or tube feeding, respectively. Results: The results showed after taking glutamine granules for 14 days, plasma glutamine concentration was significantly higher in Gln group than that in B group (607.86±147.25 mmol/L vs 447.63±132.38 mmol/L). On the other hand, the cellular immunity function were improved in Gln group, such as lymphocyte transformation ratio, NPI, CD4/CD8 ratio and IL-2 level in Gln group were significant higher than those in B group, but the humoral immunity function such as the concentration of IgG, IgM, C3, C4 were no marked changes compare with B group. In addition, the wound healing was better and hospital stay days were reduce in Gln group (46.59±12.98 days vs 55.68±17.36 days). Conclusion: These indicated that supplemented glutamine could abate the degree of immuno suppression, improve immunological function, especially cellular immunity function, ameliorate wound healing and reduce hospital stay obviously. Disclosure of Interest: None Declared

PP018-SUN EFFECTS OF GLYCINE SUPPLEMENTATION ON ALLEVIATING RAT MYOCARDIAL DAMAGE AND IMPROVING CARDIAC FUNCTION AFTER SEVERE BURN INJURY X. Peng1 , Y. Zhang1 . 1 State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burns of PLA, Southwest Hospital, Third Military Medical University, Chongqing, China Rationale: Glycine has been shown to participate in cytoprotection from hypoxia/reoxygenation injury. However, the cardioprotective effect of glycine after burn injury remains unclear. This study aims to explore the protective effect of glycine on myocardial damage in severely burned rats. Methods: Seventy-two Wistar rats were randomly divided into three groups: normal controls (C), burned controls (B), and glycine-treated group (G). Groups B and G were inflicted with 30% total body surface area of full-thickness burn. Group G was administered 1.5 g/(kg·d) glycine and group B was given the same dose of alanine via intragastric administration for 3 days. Serum creatine kinase (CK), lactate dehydrogenase (LDH), aspartate transaminase (AST), and blood lactic acid levels, as well as myocardium ATP and glutathione (GSH) contents, were measured. The indices of cardiac contractile function and histopathological changes were analyzed at 12, 24, 48, and 72 post-burn hours. Results: Serum CK, LDH, AST, and blood lactic acid levels increased, while myocardial ATP and GSH contents decreased in both burned groups. Compared with group B, the levels of CK, LDH, and AST significantly decreased, whereas the blood lactic acid, as well as myocardial ATP and GSH contents increased in group G. Moreover, cardiac contractile function inhibition and myocardial histopathological damage in group G significantly decreased compared with group B. Conclusion: Myocardial histological structure and function were damaged significantly after burn injury. Glycine is beneficial to myocardial preservation by improving cadiocyte energy metabolism and increasing ATP and GSH syntheses. Disclosure of Interest: None Declared

Poster presentations PP019-SUN A RANDOMISED CONTROL TRIAL INVESTIGATING THE EFFECTS OF PARENTERAL FISH OIL ON OUTCOMES IN CRITICALLY ILL SEPTIC PATIENTS T. Hall1 , D.K. Bilku1 , D. al-Leswas1 , C.P. Neal1 , J. Cooke1 , C. Horst1 , M.S. Metcalfe1 , A.R. Dennison1 . 1 Leicester General Hospital, UK, Leicester, United Kingdom Rationale: Sepsis is a leading cause of mortality in critically ill patients on the intensive care unit (ICU). Death from sepsis in the ICU is frequently preceded by the development of multiple organ failure as a result of uncontrolled inflammation. Treatment with omega-3 (fish oil) has been demonstrated to attenuate the effects of uncontrolled inflammation and may be clinically beneficial in reducing morbidity and mortality from organ dysfunction. Methods: A randomised control trial investigating the effects of parenteral omega-3 (OmegavenTM ), given early in the course of sepsis, was carried out in a single institution. Consecutive patients diagnosed with sepsis were entered into the study. Patients were randomised to receive either parenteral fish oil and standard medical care or standard medical care only. The primary outcome measure was a reduction in organ dysfunction using the SOFA score as a surrogate marker. The secondary outcome measures were mortality, length of stay, maximum C-reactive protein (CRP) and days free of organ dysfunction/failure. Results: Sixty patients were included in the study. The baseline demographics were matched for the two cohorts. Patients treated with parenteral fish oil were associated with a significant reduction in new organ dysfunction (delta-SOFA 2.2±2.2 vs. 1.0±1.5, p = 0.005 and maximum-SOFA 10.1±4.2 vs. 8.1±3.2, p = 0.041) and maximum CRP (186.7±78 vs. 141.5±62.6, p = 0.019). There was no significant reduction in the length of ICU and total hospital stay between cohorts. Patients treated with fish oil in the strata of less severe sepsis had a significant reduction in mortality (p = 0.042). Conclusion: The treatment of critically ill septic patients with parenteral fish oil is safe. It is associated with a significant reduction in organ dysfunction and CRP. It may be associated with a reduction in mortality in patients with less severe sepsis. Disclosure of Interest: None Declared

PP020-SUN DAY BY DAY VARIABILITY OF RESTING ENERGY EXPENDITURE (REE) IN MULTIPLE TRAUMA PATIENTS R. Anbar1 , M. Theilla1 , I. Kagan1 , S. Lev1 , L. Lupinski1 , M. Grunev1 , P. Singer1 . 1 General Intensive Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel Rationale: The REE time variations have been described in 1979 by Long and are the reference of almost all textbooks [1]. However, significant progresses in disease therapies, mechanical ventilation, sedation and analgesia have been achieved and we propose to rechallenge the described course of the disease though time with observations from our department.