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Intensive Care Medicine
Published in: Intensive Care Medicine 6/2005

01-06-2005 | Pediatric Original

Comparative effects of early randomized immune or non-immune-enhancing enteral nutrition on cytokine production in children with septic shock

Authors: George Briassoulis, Olga Filippou, Maria Kanariou, Tassos Hatzis

Published in: Intensive Care Medicine | Issue 6/2005

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Abstract

Objective

To compare the effect of early enteral feeding using immune-enhancing (IE) vs. non-immune-enhancing (NIE) formulas on cytokines in children with septic shock.

Design and setting

A single-center, randomized, blinded controlled trial in a pediatric intensive care unit of a university hospital.

Patients

We randomized 38 patients with septic shock to either IE or NIE. Feedings were advanced to a target volume of energy intake equal to 1/2, 1, 5/4, 6/4, and 6/4 of the predicted basal metabolic rate on days 1–5, respectively.

Measurements and results

Interleukins (IL) 1β, 6, and 8, tumor necrosis factor α, C-reactive protein, Pediatric Risk of Mortality (PRISM) score, survival, secondary infections, length of stay, and mechanical ventilation were compared within and between the two groups. Actual mean energy and protein intakes did not differ between the two groups and the caloric-protein balance was not correlated to cytokine levels. On day 5 IL-6 levels were significantly lower (11.8±2.4 vs. 38.3±3.6) and IL-8 significantly higher in the IE than in the NIE group (65.4±17 vs. 21±2.5). After 5 days of nutritional support a significant decrease in IL-6 levels was recorded only in group IE (mean of paired differences 39.4±3 pg/ml). In multivariate regression analysis the variation in cytokines was independently correlated only to PRISM (R2=−0.50), but pediatric intensive care unit outcome endpoints did not differ between the two groups.

Conclusions

Early IE nutrition may modulate cytokines in children with septic shock, but there is no evidence that this immunomodulation has any impact on short-term outcome.
Literature
1.
Pathan N, Hemingway CA, Alizadeh AA, Stephens AC, Boldrick JC, Oragui EE, McCabe C, Welch SB, Whitney A, O’Gara P, Nadel S, Relman DA, Harding SE, Levin M (2004) Role of interleukin 6 in myocardial dysfunction of meningococcal septic shock. Lancet 363:203–209
2.
Sparkman L, Boggaram V (2004) Nitric oxide increases IL-8 gene transcription and mRNA stability to enhance IL-8 gene expression in lung epithelial cells. Am J Physiol Lung Cell Mol Physiol 287:L764–773
3.
Tamion F, Richard V, Sauger F, Menard JF, Girault C, Richard JC, Thuillez C, Leroy J, Bonmarchand G (2003) Gastric mucosal acidosis and cytokine release in patients with septic shock. Crit Care Med 31:2137–2143
4.
Luiking YC, Poeze M, Dejong CH, Ramsay G, Deutz NE (2004) Sepsis: An arginine deficiency state? Crit Care Med 32:2135–2145
5.
Cunneen J, Cartwright M (2004) The puzzle of sepsis: fitting the pieces of the inflammatory response with treatment. AACN Clin Issues 15:18–44
6.
Yang K, Azoulay E, Attalah L, Zahar JR, Van de Louw A, Cerf C, Soussy CJ, Duvaldestin P, Brochard L, Brun-Buisson C, Harf A, Delclaux C (2003) Bactericidal activity response of blood neutrophils from critically ill patients to in vitro granulocyte colony-stimulating factor stimulation. Intensive Care Med 29:396–402
7.
Heller AR, Heller SC, Borkenstein A, Stehr SN, Koch T (2003) Modulation of host defense by hydrocortisone in stress doses during endotoxemia. Intensive Care Med 29:1456–1463
8.
McCowen KC, Bistrian BR (2003) Immunonutrition: problematic or problem solving? Am J Clin Nutr 77:764–770
9.
Galban C, Montejo JC, Mesejo A, Marco P, Celaya S, Sanchez-Segura JM, Farre M, Bryg DJ (2000) An immune-enhancing diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients. Crit Care Med 28:643–648
10.
Bower RH, Cerra FB, Bershadsky B, Licari JJ, Hoyt DB, Jensen GL, Van Buren CT, Rothkopf MM, Daly JM, Adelsberg BR (1995) Early enteral administration of a formula (Impact) supplemented with arginine, nucleotides, and fish oil in intensive care unit patients: results of a multicenter, prospective, randomized, clinical trial. Crit Care Med 23:436–449
11.
Stechmiller JK, Childress B, Porter T (2004) Arginine immunonutrition in critically ill patients: a clinical dilemma. Am J Crit Care 13:17–23
12.
Members of the American college of chest physicians / society of critical care medicine consensus conference committee (1992) American college of chest physicians / society of critical care medicine consensus conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis (review). Crit Care Med 27:864–874
13.
Pollack MM, Ruttimann UE, Getson PR (1988) Pediatric risk of mortality (PRISM) score. Crit Care Med 16:1110–1116
14.
Keene AR, Cullen DJ (1983) Therapeutic Intervention Scoring System: Update 1983. Crit Care Med 11:1–3
15.
Wilkinson JD, Pollack MM, Glass NL, Kanter RK, Katz RW, Steinhart CM (1987) Mortality associated with multiple organ system failure and sepsis in pediatric intensive care unit. J Pediatr 111:324–328
16.
Briassoulis G, Venkataraman S, Thompson A (2000) Energy expenditure in critically ill children. Crit Care Med 28:1166–1172
17.
World Health Organization (1985) Energy and protein requirements: report of a joint FAO/WHO/UNU expert consultation. WHO technical report series no 724. World Health Organization, Geneva
18.
Schofield WN (1985) Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr 39C [Suppl S]:5–41
19.
Seashore JH (1984) Nutritional support of children in the intensive care unit. Yale J Biol Med 57:111–134
20.
Food and Nutritional Research Council Subcommittee on the Tenth Edition of he RDAs (1989) Recommended dietary allowances, 10th edn. National Academy, Washington, pp 25–77
21.
Bertolini G, Iapichino G, Radrizzani D, Facchini R, Simini B (2003) Early enteral immunonutrition in patients with severe sepsis: results of an interim analysis of a randomised multicentre clinical trial. Intensive Care Med 29:834–840
22.
Katz MH (2003) Multivariable analysis: a primer for readers of medical research. Ann Intern Med 138:644–650
23.
Suchner U, Kuhn KS, Furst P (2000) The scientific basis of immunonutrition. Proc Nutr Soc 59:553–563
24.
Weiss M, Voglic S, Harms-Schirra B, Lorenz I, Lasch B, Dumon K, Gross-Weege W, Schneider EM (2003) Effects of exogenous recombinant human granulocyte colony-stimulating factor (filgrastim, rhG-CSF) on neutrophils of critically ill patients with systemic inflammatory response syndrome depend on endogenous G-CSF plasma concentrations on admission. Intensive Care Med 29:904–914
25.
Calder PC (2003) Immunonutrition. BMJ 327:117–118
26.
Yeh CL, Yeh SL, Lin MT, Chen WJ (2002) Effects of arginine-enriched total parenteral nutrition on inflammatory-related mediator and T-cell population in septic rats. Nutrition 18:631–635
27.
Wu GH, Zhang YW, Wu ZH (2001) Modulation of postoperative immune and inflammatory response by immune-enhancing enteral diet in gastrointestinal cancer patients. World J Gastroenterol 7:357–362
28.
Kemen M, Senkal M, Homann HH, Mumme A, Dauphin AK, Baier J, Windeler J, Neumann H, Zumtobel V (1995) Early postoperative enteral nutrition with arginine-omega-3 fatty acids and ribonucleic acid-supplemented diet versus placebo in cancer patients: an immunologic evaluation of Impact. Crit Care Med 23:652–659
29.
Yeh SL, Yeh CL, Lin MT, Lo PN, Chen WJ (2001) Effects of glutamine-supplemented total parenteral nutrition on cytokine production and T cell population in septic rats. JPEN J Parenter Enteral Nutr 25:269–274
30.
Peck OM, Williams DL, Breuel KF, Kalbfleisch JH, Fan H, Tempel GE, Teti G, Cook JA (2004) Differential regulation of cytokine and chemokine production in lipopolysaccharide-induced tolerance and priming. Cytokine 26:202–208
31.
Sprong T, Moller AS, Bjerre A, Wedege E, Kierulf P, van der Meer JW, Brandtzaeg P, van Deuren M, Mollnes TE (2004) Complement activation and complement-dependent inflammation by Neisseria meningitidis are independent of lipopolysaccharide. Infect Immun 72:3344–3349
32.
Smith RL, Chong TW, Hughes MG, Hedrick TL, Evans HL, McElearney ST, Saalwachter AR, Raymond DP, Du K, Rudy CK, Pruett TL, Sawyer RG (2004) Impact of immunomodulatory oligodeoxynucleotides on cytokine production in the lipopolysaccharide-stimulated human whole blood model. Surgery 136:464–472
33.
Schneider EM, Lorenz I, Ma X, Weiss M (2003) G-CSF modulates LPS-induced apoptosis and IL-8 in human microvascular endothelial cells: involvement of calcium signaling. Ann N Y Acad Sci 1010:78–85
34.
Gogos CA, Skoutelis A, Lekkou A, Drosou E, Starakis I, Marangos MN, Bassaris HP (2004) Comparative effects of ciprofloxacin and ceftazidime on cytokine production in patients with severe sepsis caused by gram-negative bacteria. Antimicrob Agents Chemother 48:2793–2798
35.
Kleijn ED de, de Groot R, Hack CE, Mulder PG, Engl W, Moritz B, Joosten KF, Hazelzet JA (2003) Activation of protein C following infusion of protein C concentrate in children with severe meningococcal sepsis and purpura fulminans: a randomized, double-blinded, placebo-controlled, dose-finding study. Crit Care Med 31:1839–1847
36.
Bergmann M, Gornikiewicz A, Tamandl D, Exner R, Roth E, Fugger R, Gotzinger P, Sautner T (2003) Continuous therapeutic epinephrine but not norepinephrine prolongs splanchnic IL-6 production in porcine endotoxic shock. Shock 20:575–581
37.
Taniguchi T, Kanakura H, Takemoto Y, Kidani Y, Yamamoto K (2003) Effects of ketamine and propofol on the ratio of interleukin-6 to interleukin-10 during endotoxemia in rats. Tohoku J Exp Med 200:85–92
38.
Heyland DK, Samis A (2003) Does immunonutrition in patients with sepsis do more harm than good? Intensive Care Med 29:669–671
39.
Bansal V, Ochoa JB (2003) Arginine availability, arginase, and the immune response. Curr Opin Clin Nutr Metab Care 6:223–228
40.
Que LG, George SE, Gotoh T, Mori M, Huang YC (2002) Effects of arginase isoforms on NO Production by nNOS. Nitric Oxide 6:1–8
41.
Mayer K, Fegbeutel C, Hattar K, Sibelius U, Kramer HJ, Heuer KU, Temmesfeld-Wollbruck B, Gokorsch S, Grimminger F, Seeger W (2003) Omega-3 vs omega-6 lipid emulsions exert differential influence on neutrophils in septic shock patients: impact on plasma fatty acids and lipid mediator generation. Intensive Care Med 29:1472–1481
42.
Grimble RF (2001) Nutritional modulation of immune function. Proc Nutr Soc 60:389–397
43.
Knight DJ (2003) Immunonutrition: increased mortality is associated with immunonutrition in sepsis. BMJ 327:682–683
44.
Montejo JC, Zarazaga A, Lopez-Martinez J, Urrutia G, Roque M, Blesa AL, Celaya S, Conejero R, Galban C, Garcia de Lorenzo A, Grau T, Mesejo A, Ortiz-Leyba C, Planas M, Ordonez J, Jimenez FJ; Spanish Society of Intensive Care Medicine and Coronary Units Immunonutrition in the intensive care unit (2003) A systematic review and consensus statement. Clin Nutr 22:221–233
Metadata
Title
Comparative effects of early randomized immune or non-immune-enhancing enteral nutrition on cytokine production in children with septic shock
Authors
George Briassoulis
Olga Filippou
Maria Kanariou
Tassos Hatzis
Publication date
01-06-2005
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 6/2005
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-005-2631-3

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