J Med Assoc Thai 2003; 86 (6):552

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Comparison of a Immunonutrition Formula Enriched Arginine, Glutamine and Omega-3 Fatty Acid, with a Currently High-Enriched Enteral Nutrition for Trauma Patients
Chuntrasakul C Mail, Siltham S , Sarasombath S , Sittapairochana C , Leowattana W , Chockvivatanavanit S , Bunnak A

The severe trauma or bum patients required aggressive resuscitation, operation and metabolic
support to reduce morbidity and motality. Nutrition is one of the most important treatment for these
patients, improving body protein and immune function, reducing rate of infection and shortening hos-
pitalization.
Method : To evaluate the metabolic and immune effects of dietary arginine, glutamine and
omega-3 fatty acids (fish oil) supplementation, we performed a prospective study in patients age 15-60
yrs after severe trauma (Injury Severity Scores (ISS) 15-30) or bum patients (body surface area (BSA)
30-60%) in Siriraj Hospital. They were randomized to receive either Neomune or Traumacal. The naso-
gastric feeding was started in post-injury day 2 (PID2) with half of concentration at the rate of 30 ml/h.
From PID3 to PID 10, the normal concentration was administered at the rate of 80-100 ml/h depending
on optimal caloric requirement. All patients received 5 per cent dextrose in half or full strength saline
solution as clinically indicated. No other oral nutrients apart from study formula were allowed during
the study. Blood sample was with-drawn on PID2, PID6 and PID11 for measurements of CBC, coagulo-
gram, albumin, transferrin, CRP, LFT, BUN, Cr, CD
3
,
CD
19
,
CD
4
,
CD
8
,
C
3
,
lgG, lgM, and lgA. Nitrogen
balance was calculated from UUN. Unpaired student t-test was applied to compare variables between
the two groups.
Results: 36 patients were selected (16 trauma and 20 bum), male= 29, mean age= 29.86 yrs.
The patients were divided equally into two groups to receive Neomune or Traumacal. The data were com-
pared and showed significance on total protein on PID11 (Neomune = 6.52
เธ‘
1.29, Traumacal =
5.59
เธ‘
1.21, p = 0.03) and serum triglycerides on PID11 (Neomune = 128.39
เธ‘
53.45, Traumacal = 186.25
เธ‘
84.07, p = 0.02). The ICU stay was observed shorter in Neomune than in Traumacal group (3.41 and
7.83 days) with no statistical significance. The wean-off respirator day was also shorter in Neomune
than in Traumacal group (2.71 and 7.39 days). One patient in each group died.
Vol.86 No.6
COMPARISON STUDY OF NUTRITIONAL FORMULA FOR TRAUMA PATIENTS
553
Conclusions : The feeding of Neomune in critically injured patients was well tolerated as
Traumacal and significant improvement was observed in serum protein. Shorten ICU stay and wean-off
respirator day may benefit from using the immunonutrient formula.
Key word : Immunonutrition, Arginine, Glutamine Omega-3 Fatty Acid, Trauma, Bum

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