Artificial nutrition after major abdominal surgery: impact of route of administration and composition of the diet
Braga, M.; Gianotti, L.; Vignali, A.; Cestari, A.; Bisagni, P.; Di Carlo, V.
Critical Care Medicine 26(1): 24-30
1998
ISSN/ISBN: 0090-3493 PMID: 9428539 Document Number: 494922
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, 38.4R 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.