Synbiotics, prebiotics, glutamine, or peptide in early enteral nutrition: A randomized study in trauma patients

Background: Since the hepatosplanchnic region plays a central role in development of multiple-organ failure and infections in critically ill trauma patients, this study focuses on the influence of glutamine, peptide, and synbiotics on intestinal permeability and clinical outcome. Methods: One hundred thirteen multiple injured patients were prospectively randomized into 4 groups: group A, glutamine; B, fermentable fiber; C, peptide diet; and D, standard enteral formula with fibers combined with Synbiotic 2000 (Synbiotic 2000 Forte; Medifarm, Sweden), a formula containing live lactobacilli and specific bioactive fibers. Intestinal permeability was evaluated by measuring lactulose-mannitol excretion ratio on days 2, 4, and 7. Results: No differences in days of mechanical ventilation, intensive care unit stay, or multipleorgan failure scores were found between the patient groups. A total of 51 infections, including 38 pneumonia, were observed, with only 5 infections and 4 pneumonias in group D, which was significantly less than combined infections (p =.003) and pneunionias (p =.03) in groups A, B, and C. Intestinal permeability decreased only in group D, from 0.148 (0.0560.240) on day 4 to 0.061 (0.040-0.099) on day 7; (p <.05). In group A, the lactulose-mannitol excretion ratio increased significantly (p <.02) from 0.050 (0.013-0.116) on day 2 to 0.159 (0.088-0.311) on day 7. The total gastric retention volume in 7 days was 1150 (785-2395) mL in group D, which was significantly more than the 410 (382-1062) mL in group A (p <.02), and 620 (337-1190) mL in group C (p <.03). Conclusions: Patients supplemented with synbiotics did better than the others, with lower intestinal permeability and fewer infections.