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document
TEN versus TPN following major abdominal trauma -- reduced septic morbidity . Recent animal models suggest that enteral feeding ( TEN ) compared to parenteral nutrition ( TPN ) improves resistance to infection . This prospective clinical trial examined the impact of early TEN vs. TPN in the critically injured . Seventy-five patients with an abdominal trauma index ( ATI ) greater than 15 and less than 40 were randomized at initial laparotomy to receive either TEN ( Vivonex TEN ) or TPN ( Freamine HBC 6.9 % and Trophamine 6 % ) ; both regimens contained 2.5 % fat , 33 % branched chain amino acids , and had a calorie to nitrogen ratio of 150:1 . TEN was delivered via a needle catheter jejunostomy . Nutritional support was initiated within 12 hours postoperatively in both groups , and infused at a rate sufficient to render the patients in positive nitrogen balance . The study groups ( TEN = 29 vs TPN = 30 ) were comparable in age , injury severity and initial metabolic stress . Jejunal feeding was tolerated unconditionally in 25 ( 86 % ) of the TEN group . Nitrogen balance remained equivalent throughout the study period , at day 5 TEN = -0.3 +/- 1.0 vs. TPN 0.1 +/- 0.8 gm/day . Traditional nutritional protein markers ( albumin , transferrin , and retinol binding protein ) were restored better in the TEN group . Infections developed in 5 ( 17 % ) of the TEN patients compared to 11 ( 37 % ) of the TPN group . The incidence of major septic morbidity was 3 % ( 1 = abdominal abscess ) in the TEN group contrasted to 20 % ( 2 = abdominal abscess , 6 = pneumonia ) with TPN . This clinical study demonstrates that TEN is well tolerated in the severely injured , and that early feeding via the gut reduces septic complications in the stressed patient .
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Intervention_Physical
TEN
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Intervention_Physical
TPN
66742
Intervention_Physical
enteral feeding ( TEN )
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Intervention_Physical
parenteral nutrition ( TPN )
66744
Intervention_Physical
TEN
66745
Intervention_Physical
TPN
66746
Intervention_Surgical
initial laparotomy
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Intervention_Pharmacological
TEN
66748
Intervention_Pharmacological
TPN
66749
Intervention_Physical
TEN
66750
Intervention_Physical
TEN
66751
Intervention_Physical
TPN
66752
Intervention_Physical
TEN
66753
Intervention_Physical
TEN
66754
Intervention_Physical
TPN
66755
Intervention_Physical
TEN
66756
Intervention_Physical
TEN
66757
Intervention_Physical
TPN
66758
Intervention_Physical
TEN
66759
Intervention_Physical
TPN
66760
Intervention_Physical
TEN
66761
Outcome_Other
tolerated
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Outcome_Physical
Nitrogen balance
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Outcome_Physical
nutritional protein markers ( albumin , transferrin , and retinol binding protein )
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Outcome_Adverse-effects
Infections
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Outcome_Physical
major septic morbidity
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Participant_Condition
major abdominal trauma
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Participant_Condition
septic morbidity
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Participant_Condition
critically injured
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Participant_Sample-size
Seventy-five
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Participant_Condition
abdominal trauma
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Participant_Condition
laparotomy
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Participant_Condition
severely injured