Format

Send to:

Choose Destination
See comment in PubMed Commons below
Crit Care Med. 1998 Jan;26(1):24-30.

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

Author information

  • 1Department of Surgery, Scientific Institute San Raffaele, University of Milan, Italy.

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.

Comment in

PMID:
9428539
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Lippincott Williams & Wilkins
    Loading ...
    Write to the Help Desk