| Clin Nutr 2001 Aug;20(4):301-5
fiber reduces the incidence of diarrhea in septic patients receiving
total enteral nutrition: a prospective, double-blind, randomized,
and controlled trial.
Spapen H, Diltoer M, Van Malderen C, Opdenacker G, Suys E,
Intensive Care Department, Academic Hospital, Vrije Universiteit
BACKGROUND AND AIMS: Attempts to control enteral nutrition associated
diarrhea in the critically ill tube-fed patient by implementing
feeding formulas enriched with fiber were mostly unsuccessful.
Recently, it was shown that enteral feeding containing soluble
partially hydrolyzed guar decreased the incidence of diarrhea
in a cohort of non-critically ill medicosurgical patients. We
investigated whether this type of enteral feed could also influence
stool production in patients with severe sepsis, a population
at risk for developing diarrhea. METHODS: The study was double-blind.
Patients with severe sepsis and septic shock were consecutively
enrolled and at random received either an enteral formula supplemented
with 22 g/l partially hydrolyzed guar or an isocaloric isonitrogenous
control feed without fiber. All patients were mechanically ventilated
and treated with catecholamines and antibiotics. Enteral feeding
was provided through a nasogastric tube for a minimum of 6 days.
A semiquantitative score based on stool volume and consistency
was used for daily assessment of diarrhea. RESULTS: 25 patients
fulfilled the criteria for data analysis. Soluble fiber was
administered in 13 of them. The two groups were well-matched
for gender, age, disease severity, cause of sepsis, laboratory
parameters, total feeding days and time to reach nutritional
goals. The mean frequency of diarrhea days was significantly
lower in patients receiving fiber than in those on standard
alimentation (8.8+/-10.0 % vs 32.0+/-15.3 %; P=0.001). The whole
group of fiber-fed patients had less days with diarrhea per
total feeding days (16/148 days (10.8%) vs 46/146 days (31.5%);
P<0.001) and a lower mean diarrhea score (4.8+/-6.4 vs 9.4+/-10.2;
P<0.001). The type of enteral diet did not influence sepsis-related
mortality and duration of stay in the intensive care unit. CONCLUSION:
Total enteral nutrition supplemented with soluble fiber is beneficial
in reducing the incidence of diarrhea in tube-fed full-resuscitated
and mechanically ventilated septic patients. Copyright 2001
Harcourt Publishers Ltd.
- Clinical Trial
- Randomized Controlled Trial