Praecox postoperative enteral nutrition: preliminary experience

Stress reaction is known to result from major surgery, which causes the release of macrophages, monocytes, eicosanoids and cytokines. These, in turn, activate the adrenal gland, hypothalamus and so that this reaction is provoked, coupled with fever and anorexia. Such a reaction leads to rapid muscle tissue loss due to neoglucogenetic protein catabolism, acute phase protein synthesis, edema and constriction of the splanchnic blood vessels. Reduced blood-flow in the digestive system allows the passage of bacteria and endotoxins from the intestinal lumen, thus penetrating the mucous membrane through blood circulation. This latter phenomenon, "bacteria translocation", if not adequately treated can develop into multivisceral insufficiency, MOFS (Multi-Organ Failure Syndrome) or (Whole Body Inflammation). We can effectively prevent "bacteria translocation" by two methods: Praecox Post Operative Enteral Nutrition (PPOEN) and Immune Enteral Nutrition the administration of a semi-elemental formula containing immunonutrients. METHOD. Between June 1999 and May 2001, we treated 10 patients at the General Surgery Department "Paride Stefanini" and wards of the Emergency Department of the University Hospital "Policlinico Umberto I" in Rome, according to the following criteria: access to the digestive tract by means of the Dobbhoff tube and the immune nutritional dosage conveyed by a peristaltic pump, according to the Harris-Benedict formula increased by 50%. The hydroelectrolite balance was ensured by the administration of polyelectrolite, saline and glucose solution via a peripheral vein on 12-hour schedule. It began with of fluid therapy and no IEN. After the first 12 hours IEN was started at with a corresponding reduction in fluid volume. This procedure continued until IEN reached the maximum calorie/volume regimen between the 72nd and 84th hour. This group was matched with another 10 patient group with the same age, sex and submitted to the same operation, treated with conventional therapy. Total proteinemia (TP), Albuminemia (Alb), Transferrinemia (TRF) and weight were considered for nutritional evaluation. For the assessment of patients' immune system, lymphatic squaring, CD3, CD4, CD8, CD8a were studied. RESULTS. We show the average variations expressed as a percentage: PT = +4,19; Alb= +17,6; TRF = +46,11; Weight = +1,98; CD3 = +17,06; CD4 = +16,47; CD8 =+ 19,83; CD8a = +6,66. DISCUSSION. Data analysis shows a moderate improvement in nutritional parameters with a favourable reaction in the lymphatic squaring without either surgical or metabolic complications. Although preliminary, our results are encouraging. While waiting for more consistent statistics, our data confirm the currently accepted concept on the role played by immunonutrients. In conclusion, we think that PPONE integrated with IEN can provide a positive approach in the prevention of MOFS and WBI as well as a reduction in antibiotic consumption, recovery time and, perhaps above all, in the amount of money to spend -whatever the outcome.