Effect of two preoperative oral immune-enhancing nutritional supplements in patients at high
risk of infection after cardiac surgery: a randomized placebo-controlled study.
Introduction: In our first study we showed that the use of a preoperative oral
immune-enhancing nutritional supplement (OIENS) resulted in an improved patients'
host-defence with a reduction in postoperative infectious morbidity in 'high-risk' cardiac
surgery patients. The use of the OIENS resulted also in less postoperative organ dysfunction.
Experimental studies have shown that additional glycine results in less ischemia-reperfusion
damage and that glycine has anti-inflammatory properties.
Objective: The use of an OIENS in the preoperative period in patients at high risk of
infection after elective cardiac surgery with the use of cardiopulmonary bypass (CPB) results
in a reduction in infections as in our first study. The addition of 9.6 gram glycine per
sachet OIENS results in a further reduction in postoperative dysfunction.
Design: A prospective randomized placebo controlled study with two oral immune enhancing
nutritional formula's and an isocaloric control formula. Patients: Seventy-four consecutive
patients undergoing cardiac surgery with the use of an CPB who met one or more of the
following inclusion criteria: Age 70 years or older, mitral valve replacement or cardiac
ejection fraction less then 40%. Exclusion criteria were age < 18 years, proven malignancy,
use of corticosteroids, severe renal and liver failure. Definition of a protocol violation
was the intake of less then 5 L or more then 10 L of the nutritional supplement in the
preoperative period.
Intervention: Patients were split up in three groups by concealed randomisation. One group
received the arginine, omega3-PUFAs and nucleotides enriched formula (OIENS). Another group
received the OIENS further enriched with glycine (OIENS+glyc). The control group received an
isocaloric nutritional supplement without the enrichments.
Phase:
N/A
Details
Lead Sponsor:
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)