Ventilatör ilişkili pnömoni gelişimini önlemede, glutamin destekli total parenteral beslenmenin, glutaminsiz enteral ve total parenteral beslenme ile karşılaştırılması

Abstract

Bu çalismada, mekanik ventilatör destegi saglanan hastalarda, ventilatör iliskilipnömoni gelisimini önlemede, glutamin destekli total parenteral beslenme nin (TPN), enteralve total parenteral beslenmeye bir üstünlügü olup olmadiginin arastirilmasi amaçlandi.Mekanik ventilatör destegine ihtiyaci olan, yogun bakim ünitesine alinan 60 olgu,rastgele 3 gruba ayrildi. Birinci gruba enteral, ikinci gruba TPN, üçüncü gruba ise glutamindestekli TPN baslandi. Hastalarda 7 gün boyunca ventilatör iliskili pnömoni gelisipgelismedigi takip edildi.Gruplar arasinda demografik veriler, kronik hastalik, steroid tedavisi, gögüs tüpüvarligi, derin trakeal aspirat kültürleri ve kan kültüründe üreme, gram yaymadamikroorganizma ve lökosit görülmesi, ates, lökositoz, sekresyon artisi, ral, O2 ihtiyacindaartis, akciger infiltrasyonu ve VIP gelisimi açisindan istatistiksel olarak fark bulunmadi. Ates,lökositoz, CRP ve sedimentasyon degerleri arasinda herhangi bir korelasyon görülmedi.Sonuç olarak VIP, glutamin destekli TPN grubunda daha az gelismesine karsilik,gruplar arasindaki farklilik istatistiksel olarak anlamli bulunmadi. Glutamin destekli TPN nin,VIP gelisimin önlemede, enteral beslenme ve tek TPN'ye bir üstünlügü olmadigi kanisinavarildi. Bu konuda daha ileri çalismalar yapilmasina ihtiyaç vardir.3

In this study, we aimed to investigate whether glutamine enriched total parenteralnutrition (TPN) may be superior to enteral feeding or TPN in order to prevent ventilator-associated pneumonia in mechanically ventilated patients.Sixty patients who were followed in intensive care unit for need to mechanicalventilation support were randomly allocated in three groups. The patients of first group werefeeded enteraly, second group with TPN and third group with glutamine enriched TPN. Thepatients were followed seven days for ventilator associated pneumonia with clinical andlaboratory findings.There were no stastically differences between three groups for demographics, chronicillness, steroid treatment, microbial growth in deep tracheal aspiration cultures and bloodcultures, microorganisms and leukocyte in gram stain method, chest tube placement, fever,leukocytosis, secretion, crackles, supplemental oxygen support, lung infiltration and VAP.There was not a correlation between fewer, leukocytosis, CRP and sedimentation.As a result, the incidence of VAP was lower in glutamine enriched TPN groupcompared to other groups, but this was not stastically significant. We concluded thatglutamine enriched TPN is not superior to enteral feeding or TPN alone for preventing VAP.We think that further studies should be carried out for this subject.4