Effects of early enteral feeding on the prevention of enterogenic infection in severely burned patients

The aim of the study was to analyse the effects of early enteral feeding on the prevention of enterogenic infection in severely burned patients. A total of 22 patients with severe burns were randomly divided into an early enteral feeding group (EF) and a delayed enteral feeding group (DF). The levels of serum endotoxin and TNF-alpha were dynamically detected in the members of both groups, and two unmetabolized sugars (lactulose and mannitol) were orally administered to these patients 1, 3 and 5 days postburn. Intestinal permeability was evaluated by detecting the concentrations of lactulose and mannitol in the urine and the lactulose-mannitol ratio (L-M) ratio. The levels of serum endotoxin and TNF-alpha in severely burned patients were significantly higher than in normal subjects (P < 0.01). The endotoxin level was positively related to the TNF- level (r(EF) = 0.93, P < 0.01; r(DF) = 0.80, P < 0.05). The urinary lactulose levels in both groups were significantly higher than in normal (P < 0.01), the urinary mannitol levels showed no obvious changes (P > 0.05). The urinary L/M ratios in both groups were significantly higher than in normal subjects (P < 0.01). The urinary L/M ratio was positively related to the serum endotoxin level (r = 0.95, P < 0.01). The urinary lactulose levels and the urinary L/M ratios in the EF group were significantly lower than in the DF group (P < 0.01). The levels of serum endotoxin and TNF- in the EF group were significantly lower than in the DF group (P < 0.01). It is suggested that intestinal permeability was markedly higher after burns than normal, and was positively related to the gut-derived endotoxemia. Early enteral feeding may decrease intestinal permeability, preserve the intestinal mucosal barrier and have a beneficial effect on the reduction of enterogenic infection. (C) 2001 Elsevier Science Ltd and ISBI. All rights reserved.