“A COMPARATIVE ANALYSIS OF PRESERVATION OF GUT FUNCTION AND IMPROVEMENT IN OUTCOMES WITH GLUTAMINE AND PROBIOTIC SUPPLEMENTATION IN TREATMENT OF MAJOR BURNS”
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Keywords
Glutamine, major burns,, Probiotics, Lactulose/Mannitol ratio, SOFA, delta SOFA, gut function
Abstract
Introduction: Burn injuries produce extensive skin barrier disruption, which creates novel sites for bacterial colonization and contributes to an immunosuppressive state, making the burn patients vulnerable to infectious complications. The dramatic increase of gut permeability with disturbance of the intestinal flora and translocation of the microorganisms and/or their products from gastrointestinal tract to extra-intestinal sites seems to contribute to systemic sepsis and associated multiple organ failure after severe burns. In this study, we have used a comparison of Urinary lactulose mannitol ratio (L/M ratio), Sequential organ failure assessment (SOFA) scores and the duration required for wound healing as parameters to assess the outcomes with glutamine and probiotic supplementation in treatment of major burns.
Material and Methods: The study included 88 patients with more than 30% TBSA burns at admission and aged between 18 and 60 years. The subjects were randomly allocated to three groups. The control group received standard nutritional supplementation, and the Glutamine test group received an additional 0.3g/kg/day of enteral glutamine supplement and probiotic test group received probiotic preparation twice daily. L/M ratio were assessed at admission and at day 14; SOFA scores were assessed at admission and on day 3, and delta SOFA (3-0) were calculated. Results were tabulated and compared statistically.
Results: The average age among the Glutamine, Probiotic groups and Control groups were [35.9 +/- 11.07] years, [36.7 +/- 9.07] years and [38.3 +/- 10.6] years respectively, with the average percentage of burns were [44.8 +/- 8.09] %TBSA, [46.9 +/- 9.5] % TBSA and [45.7 +/- 8.7] % TBSA in the three groups respectively. Significant reduction in the L/M ratio at day 14 is noted in both Glutamine and Probiotic groups when compared to Control group; however, no significant difference noted when compared with each other. Significant reduction in the duration of wound healing is noted in both Glutamine and Probiotic groups when compared to Control; however, no significant difference noted when compared with each other. The delta SOFA (3-0) score averaged [0.06 +/- 1.5], [0.3 +/- 1.3], [0.9 +/- 1.3] in the Glutamine, Probiotic and Control groups respectively.
Conclusion: Prophylactic administration of glutamine or probiotic appears to preserve gut function and improve wound healing time and overall outcome, with the former showing higher benefit as compared to the latter.
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Dr. Mohan G Kakola M. Ch
Professor, Department Of Plastic, Reconstructive Surgery And Burns Mysore Medical College And Research Institute Mysore, Karnataka, India
Dr. Chandrashekar M S, M.Ch
Assistant Professor, Department Of Plastic, Reconstructive Surgery And Burns Mysore Medical College And Research Institute Mysore, Karnataka, India
Dr. Vijaykumar N, M.Ch
Professor & Head, Department Of Plastic, Reconstructive Surgery And Burns Mysore Medical College And Research Institute Mysore, Karnataka, India
Dr. Varun Tez M.S.,(M.Ch.)
Postgraduate, Department Of Plastic, Reconstructive Surgery And Burns Mysore Medical College And Research Institute Mysore, Karnataka, India
Dr. Saikumar P., M.S., (M.Ch.)
Postgraduate, Department Of Plastic, Reconstructive Surgery And Burns Mysore Medical College And Research Institute Mysore, Karnataka, India