Intensive Care Medicine

, Volume 25, Issue 2, pp 157–161

Effects of early enteral nutrition on intestinal permeability and the development of multiple organ failure after multiple injury

Authors

  • L. Kompan
    • University Clinical Centre Ljubljana, CIT, Zaloška cesta 7, 1000 Ljubljana, Slovenia email: lidija.kompan@bfro.uni-lj.si Tel. + 386(61)1 32 60 36; Fax + 386(61)1 33 72 62
  • B. Kremžvar
    • Clinical Centre Ljubljana, Slovenia
  • E. Gadžvijev
    • Clinical Centre Ljubljana, Slovenia
  • M. Prošek
    • National Institute for Chemistry, Ljubljana, Slovenia
ORIGINAL

DOI: 10.1007/s001340050809

Cite this article as:
Kompan, L., Kremžvar, B., Gadžvijev, E. et al. Intensive Care Med (1999) 25: 157. doi:10.1007/s001340050809

Abstract

Objective: To determine how immediate enteral nutrition (EN) affects gut permeability and the development of multiple organ failure (MOF) in multiply injured patients. Design: Prospective, randomised clinical trial. Setting: 20-bed surgical intensive care unit (ICU), university hospital. Patients: 28 consecutive multiply injured patients, admitted in shock and stabilised in 6 h. Interventions: Patients were randomly assigned to EN started not later than 6 h after admission to the ICU (group A), and to EN started later than 24 h after admission (group B). Measurements and main results: The lactulose/mannitol (L/M) test was performed in patients on days 2 and 4 after trauma, and in 5 healthy volunteers. MOF scores were calculated daily. The mean MOF score from day 4 onwards was 1.84 in group A versus 2.81 in group B (p < 0.002), and was correlated with the time of initiation of EN after injury and the L/M ratio on day 2. The median L/M ratio on day 2 was 0.029 for group A and 0.045 for group B, while on day 4 it was 0.020 and 0.060, respectively. On day 2 after trauma, the L/M ratio was significantly higher in group B (p < 0.05) than in normal volunteers (median 0.014) and was positively correlated with the time of starting EN. Conclusions: In contrast with normal volunteers, the patients started on EN later than 24 h after admission to the ICU demonstrated increased intestinal permeability on the second day after sustaining multiple injury. Also, they had a more severe form of MOF than the group placed on EN immediately upon admission. However, early EN had no influence on the length of ICU stay or the time of mechanical ventilation.

Key words Gut permeability Multiple injury Early enteral nutrition Multiple organ failure Lactulose-mannitol test

Copyright information

© Springer-Verlag Berlin Heidelberg 1999