Inflammatory Adverse Effects of Two Different Parenteral Nutrition Products Used in the Intensive Care Unit

Yıl 2014, Cilt: 2 Sayı: 4, 160 - 164, 12.07.2016

Hüseyin Toman Hasan Şahin Halide Aydın Tuncer Şimşek Uğur Altınışık Hatice Betül Altınışık Tuğba Doğu

Öz

In the Intensive Care Unit (ICU) one of the most important routine treatment applications is nutritional support. In ICU parenteral nutritional products are prepared to provide for all the patient‘s needs. Insufficient nutrition may lead to insufficient inflammatory response. This study aimed to compare the inflammatory response of patients admitted to the ICU for different reasons fed soya oil-based and olive oil-based emulsions in terms of neutrophil lymphocyte rate (NLR), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), APACHE II score and SOFA scores. Our study retrospectively investigated the intensive care monitoring files and laboratory results of 25 patients with Glasgow Coma Scale 3-4. The patients given soya oil-based emulsion (Group S, n:14) and olive oil-based lipid emulsion (Group Z, n: 14) had NLR, CRP, ESR, APACHE II and SOFA scores recorded on the day they were admitted to ICU and on the 1st, 3rd, 5th and 10th day in ICU. The NLR in Group S was higher than the value in Group Z on the 5th day (p<0.05). The CRP value in Group Z was higher on the day of admittance compared to Group S (p<0.05). Comparing within Group S, the CRP value on the day of admittance was lower than the values on the other days (p<0.05). In Group S the ESR on the 5th day appeared to be higher than in Group Z (p<0.05). The APACHE II scores in Group S were higher than Group Z on the 1st, 3rd, 5th and 10th days (p<0.05). While olive oil-based lipid nutritional solutions appear to have more advantages in terms of immunoresponse compared to soya-based lipid nutritional solutions, taking note of the low number of patients in our study and the many factors not considered that may affect the situation, there is a need for prospective studies with carefully chosen patient groups and larger case numbers.

Anahtar Kelimeler

Intensive care unit, parenteral nutrition, inflammation

Yoğun Bakım Ünitesinde Kullanılan İki Farklı Paranteral Beslenme Ürününün İnflamatuar Yanıta Etkileri

Öz

Yoğun bakım ünitesinde (YBÜ) beslenme desteği en önemli rutin tedavi uygulamalarından biridir. YBÜ’de paranteral beslenme ürünleri hastaların bütün ihtiyaçlarını karşılayacak şekilde hazırlanmaktadır. Yetersiz beslenme yetersiz inflamatuar yanıta neden olabilir. Bu çalışmada, YBÜ ünitesine farklı nedenler ile yatırılan ve paranteral olarak soya yağı bazlı ve zeytinyağı bazlı emülsiyonlar ile beslenen hastaların inflamatuar yanıtının Nötrofil lenfosti oranı (NLO), C-Reaktif Protein (CRP), ESR (eritrosit sedimantasyon hızı), APACHE II skoru ve SOFA skorlarının karşılaştırılması amaçlanmıştır. Çalışmamızda Glaskow Koma Skalası 3-4 olan 25 hastanın, yoğun bakım takip dosyaları ve labartuvar sonuçları retospektif olarak incelendi. Soya yağı bazlı emülsiyon (GrupS, n:14) ve zeytinyağı bazlı lipid emülsiyon (GrupZ, n:14) kullanan hastaların YBÜ’e yatırıldığı gün, 1., 3., 5. ve 10. günlerdeki NLO, CRP, ESR, APACHE II ve SOFA skorlar kaydedildi. GrupS’nin NLO‘ı 5. günde Grup Z’ye göre yüksek bulundu (p< 0,05). Grup Z’nin CRP değeri geliş günü Grup S’ye göre yüksek bulundu (p

Anahtar Kelimeler

Yoğun bakım ünitesi, parenteral beslenme, inflamasyon

Kaynakça

• 1. Moore FA, Feliciano DV, Andrassy RJ, ve ark. Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 1992;216:172-183.
• 2. Esen F. İmmunonütriyon. AKEM Derg 2001;15:564-566.
• 3. Garnacho-Montero J, Huici-Moreno MJ, Gutierrez-Pizarraya A, ve ark. Prognostic and diagnostic value of eosinopenia, C-reactive protein, procalcitonin, and circulating cell-free DNA in critically ill patients admitted with suspicion of sepsis. Crit Care 2014;5:18.
• 4. Tasoglu İ, Turak O, Nazli Y, ve ark. Preoperative neutrophil−lymphocyte ratio and saphenous vein graft patency after coronary artery bypass grafting. Clin Appl Thromb Hemost 2014;20(8):819-824.
• 5. Yılmaz H, Cakmak M, Inan O, Darcin T, Akcay A. Can neutrophil-lymphocyte ratio be independent risk factor for predicting acute kidney injury in patients with severe sepsis?. Ren Fail 2015;37(2):225-229.
• 6. Anthony PS. Nutrition screening tools for hospitalized patients. Nutr Clin Pract 2008;23:373-382.
• 7. Türkmen A. Parenteral Ürünler. Klinik Gelişim Dergisi 2011;24:10-14.
• 8. Gürsoy N, Kaymak Ç, Özcan A, ve ark. Parenteral Beslenen Yoğun Bakım Hastalarında Soya Yağı, Zeytinyağı ve MCTLCT Bazlı Nutrisyon Solüsyonlarının Etkilerinin Karşılaştırılması. Turk Yoğun Bakım Derneği Dergisi 2012;10:52-58.
• 9. Wang H, Ye J. Regulation of energy balance by inflammation: common theme in physiology and pathology. Rev Endocr Metab Disord 2015;16(1):47-54.
• 10. Lee JH, Waller JC, Melton SL, Saxton AM, Pordesimo LO. Feeding encapsulated ground full-fat soybeans to increase polyunsaturated fat concentrations and effects on flavor volatiles in fresh lamb. J Anim Sci 2004;82(9):2734-2741.
• 11. Mateu-de Antonio J, Grau S, Luque S, Marin-Casino M, Albert I, Ribes E. Comparative effects of olive oil-based and soyabean oil-based emulsions on infection rate and leucocyte count in critically ill patients receiving parenteral nutrition. Br J Nutr 2008;99(4):846-54.
• 12. Cury-Boaventura MF, Gorjao R, de Lima TM, ve ark. Toxicity of a soybean oil emulsion on human lymphocytes and neutrophils. JPEN 2006;30:115-123.
• 13. Smyrniotis VE, Kostopanagiotou GG, Arkadopoulos NF, ve ark. Long-chain versus medium-chain lipids in acute pancreatitis complicated by acute respiratory distress syndrome: effects on pulmonary hemodynamics and gas exchange. Clin Nutr 2001;20:139-143.
• 14. Macri EV, Lifshitz F, Alsina E, ve ark. Monounsaturated fatty acids-rich diets in hypercholesterolemic-growing rats. Int J Food Sci Nutr 2015;66(4):400-408.
• 15. Wanten G. An update on parenteral lipids and immune function: only smoke, or is there any fire? Curr Opin Clin Nutr Metab Care 2006;9:79-83.