The aim of this study is to investigate the efficacy of early postoperative enteral immunonutrition on immune response and outcomes in the low operative risk cardiac surgery population with low phase angle value measured by the bioelectrical impedance analysis.
Study enrolls a low operative risk cardiac surgery patients who undergo elective cardiac surgery with cardiopulmonary bypass (CPB). Patient is offered to take part in a study a day prior to surgery. Information is provided regarding protocol, aim and course of study. Only signing the consent form patients could be enrolled to the study. Study consists of: Primary assessment - information about study. Consent form. Assessment of patient according to predefined criteria. Phase angle evaluation by bioelectrical impedance. (Day prior to surgery). It is a specific cohort of patients basically governed by surgery risk and the status of patients' cells. Euroscore II value was used to evaluate the risk of surgery. Bioelectrical impedance analysis derived phase angle was used to evaluate patients' cells frailty and vitality. First phase of blood sampling - blood samples were taken for evaluation immunological status (cellular and humoral) and inflammatory response (CRB, complete blood count) at the surgery day morning prior to surgery. Surgery - evaluating the course of the surgery (see exclusion criteria). Randomization - the patients will randomly selected into intervention and control groups. The patients, physicians and investigators were separate from this process. The selection sequence was computer-generated and provided to the researchers by the statistician. Intervention - patients in the intervention group received normal daily meals plus one sachet three times a day of immune nutrients ("Glutamine Plus" by Fresenius Kabi) for five days after the surgery. The control group was provided with normal daily meals. The patients were excluded from the study if they failed to intake all of the prescribed immunonutrients. Second phase of blood sampling - repeated taking of blood samples for evaluation immunological status (cellular and humoral) and inflammatory response (CRB, complete blood count) at the sixth day morning after the surgery. Data collection - data is recorded (demographic data of patients, co-morbidities, instrumental parameters, phase angle values, surgery course details, immunological assesment and laboratory tests, short term and long term outcomes).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
55
"Glutamine Plus" by Fresenius Kabi (one sachet composition: glutamine 10 g, carbohydrate 10 g, β-carotene 1.7 mg, vitamin E 83 mg, vitamin C 250 mg, zinc 3.4 mg, selenium 50 μg, and fibre 1.2 g).
Normal daily meal (75-80 g protein)
Vilnius University Hospital Santaros klinikos
Vilnius, Lithuania
CD4+ T cell
Blood samples were collected twice on the surgery and on the sixth postoperative day by sampling blood for CD4+ T cells.
Time frame: Six days
CD8+ T cell
Blood samples were collected twice on the surgery and on the sixth postoperative day by sampling blood for CD8+ T cells.
Time frame: Six days
CD69+ T cell
Blood samples were collected twice on the surgery and on the sixth postoperative day by sampling blood for CD69+ T cells.
Time frame: Six days
Interleukin-1 (IL-1)
Blood samples were collected twice on the surgery and on the sixth postoperative day by sampling blood for IL-1.
Time frame: Six days
Interleukin-6 (IL-6)
Blood samples were collected twice on the surgery and on the sixth postoperative day by sampling blood for IL-6.
Time frame: Six days
Tumor necrosis factor alfa (TNFα)
Blood samples were collected twice on the surgery and on the sixth postoperative day by sampling blood for TNFα.
Time frame: Six days
Acute kidney injury
Short-term postoperative outcome.
Time frame: 28 days
Stroke
Short-term postoperative outcome.
Time frame: 28 days
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ICU infectious complications
Short-term postoperative outcome. It was examined deep wound infections, ventilator associated and hospital acquired pneumonia, urinary tract infections, bloodstream infections, catheter-related bloodstream infections.
Time frame: 28 days
Duration of mechanical ventilation
Short-term postoperative outcome.
Time frame: 28 days
Retoracotomy rate
Short-term postoperative outcome.
Time frame: 28 days
Mortality
Long-term postoperative outcome.
Time frame: 2 years
Duration of hospital stay
Short-term postoperative outcome.
Time frame: 28 days
Rate of rehospitalization
Long-term postoperative outcome.
Time frame: 2 years