Assessment of stress oxidative modulation when conventional parenteral solutions were used compared with nutrition based on an olive oil compound in multiple trauma patients
KeywordsEnteral Nutrition Injury Severity Score Total Energy Intake Eicosanoide Production Multiple Trauma Patient
We studied metabolic parameters from oxidative stress response in trauma patients when using intravenous nutrition with Oliclinomel (an olive/soybean oil mixture characterized by an essential fatty acids content of 20%) or Nutriflex (an soybean oil composition).
A prospective, randomized study was conducted in a 16-bed ICU during an 8-month period: family informed consent and institutional agreement were obtained in 43 consecutive intubated multiple traumatic patients with Injury Severity Scores of 23.2 ± 10.6; 22 patients received Oliclinomel N7 (O group [Og]) and 21 patients received Nutriflex Energy (N group [Ng]) to reach equal caloric support in the two groups (50% of the energy demand at day 1 to 100% at day 3). Oxidative parameters were measured every day by blood sample analyses and capnography was used continuously. Every patient was sedated and ventilated (Vc: 6 ml/kg; rate: 12/min; PEEP 5 ± 3 mmHg) by the same approach. The study stopped on day 4 at the beginning of enteral nutrition. For statistical analysis, a Shapiro-Wilk test, a Wilcox test and a Student t test were used.
The ratio between the total energy intake and the energy expenditure was similar in both groups (Og: 0.75 ± 0.17; Ng: 0.86 ± 0.26, P = 0.24). The nitrogen balance was negative for all patients and showed no significant difference (P = 0.08). The daily amino supply showed no significant difference (Og: 0.7 ± 0.2; Ng: 0.8 ± 0.2 kcal/kg; P = 0.17).
The daily glucose intake was similar in both groups, but with a lower significant trend in Og showing a more stable glucose/ insulin ratio (P < 0.05) with a significant lower average PCO2 production (Og: 38 ± 5 mmHg; Ng: 68 ± 12 mmHg) (P < 0.01). The daily lipid intake was higher in Og (Og: 0.8 ± 0.3; Ng: 0.5 ± 0.1 g/kg; P < 0.001). The ratio triglyceride/cholesterol level was not different between groups. No fat emboly occurred in all the study population. Infection rates where similar in both groups.
The main purpose for controlling stress oxidation is to diminish eicosanoide production . By modifying the n-6/n-3 ratio in new parenteral solution we can protect the cellular membrane and promote a glucose/insulin ratio stability avoiding also further CO2 production.
- 1.Heyland , et al.: Total parenteral nutrition in the critically ill patient; a meta-analysis. JAMA 280: 2013-2019. 10.1001/jama.280.23.2013Google Scholar