Effect of Arginine Supplementation on T-Lymphocyte Function in Burn Patients

Lu, Shuliang; Gong, Q; Jin, Shuwen; Shi, Jixiang

doi:10.1097/00024382-199703001-00606

Cited by 3 publications

(6 citation statements)

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“…There are at least three pathways to prophylaxis and regulating the post-burn metabolism for the reduction or inhibition of protein catabolism: nutritional support, hormone, and medicines [61,[72][73][74][75][76][77][78][79][80][81].…”

Section: Explore Methods Of Improving and Correcting Negative Nitrogementioning

confidence: 99%

Metabolism in Burns

Wang

Deng²

2014

Chinese Burn Surgery

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Burn hypermetabolism is characterized by an elevated metabolic rate, increased protein catabolism, and energy consumption. Hypermetabolism in severe burn patient could last several weeks or longer; it is one of the most significant reactions of homeostasis. In view of this, since the 1980s, the Burns Institute of the Southwest Hospital (BISH) at the Third Military Medical University (TMMU) has investigated the general trends and rules of energy expenditure, developed a formula to calculate calorie needs in Chinese adult burn victims and the relationships between energy expense and burn area, depth, phase, prognosis, putting forward a proposal that is different from the conventional ebb and flow phase, studied the proportion of energy expense among glucose, fat, and protein, and advanced a new theory, "enterogenous hypermetabolism" and its modulation [1][2][3]. In BISH at TMMU, oxygen consumption, carbon dioxide production, and urinary nitrogen were measured in 75 burn adults on post-burn day (PBD) 1, 2, 3, 7, 14, 21, 28, and in 13 normal adults as controls. Burns covered 5-98 % (44 ± 27.2 %) of the total body surface area (TBSA), and the victims were aged 16-51 years (31.2 ± 9.9 years), 53 were male and 22 were female out of 75 cases. For burn areas less than 60 %, resting energy expenditure (REE) clearly increased, as burn area increased with an almost linear relationship between burn area and REE. When the extent of the burn area was greater than 60 %, REE did not increase or decrease as the burn area increased (Fig. 15.1). As listed in Table 15.1, if the total area of burn was similar, and the thirddegree burn was larger, the metabolic rate was markedly increased. The metabolic rate was quite different during varying time phases post-burn, its general trend was to increase gradually throughout the course of the burns, the peak value of REE was during PBD 7-21, and was progressively reduced, keeping pace with the closure of the burn wound. The dynamic curve of REE variation in the burn area of 5-98 % along with time phase was an arched curve, the back of the arch went upward ( Fig. 15.2). The differences in the peak phase of the metabolic rate were accompanied by the variation in the burn area. In patients with a small burn area, the phase peak came earlier and was shorter, while the peak came later and was sustained for longer in large burn areas. In Fig. 15.3 and Table 15.2, on PBD 1 the REE in the >71 % burn group was lower than in the other three <70 % 15

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Section: Explore Methods Of Improving and Correcting Negative Nitrogementioning

confidence: 99%

Metabolism in Burns

Wang

Deng²

2014

Chinese Burn Surgery

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“…Therefore, administration of exogenous Arg is necessary to meet the requirements of wound healing. After administration of Arg (25 g/ day) for 7 days in adults with burns in whom the plasma Arg level was continuously reduced and slightly higher than that in controls, it was signifi cantly elevated after Arg treatment for 14 days [ 89 ]. After severe trauma such as major operations and burns, the post-traumatic stress may signifi cantly increase the degradation of proteins.…”

Section: Improvement Of Nutritional Statusmentioning

confidence: 96%

“…Effectiveness of Arg may be observed in these patients after long-term treatments. Pharmacokinetic study indicated that after the consecutive administration of arginine hydrochloride (25 g/day), the plasma Arg level on 7th day was slightly higher than that of the control, and was markedly increased on the 14th day after commencing treatment with arginine hydrochloride [ 89 ]. Therefore, treatment with Arg should be administered for at least 10 days in severe burns patients.…”

Section: Dosage Course Of Treatment and Management Of Adverse Reactmentioning

confidence: 98%

Nutrition in Burns

Wang

Deng²

2014

Chinese Burn Surgery

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Enteral nutrition (EN) has followed a long history, and hyperalimentation has had an epoch-making signifi cance since the end of the 1960s. From the 1980s, enterogenous infection and the complications of the catheter, metabolism, infection, etc., have been raised, and gradually much attention has been devoted to EN and especially early feeding. We began to serially study the effect and mechanism of early EN since 1985.Overall, more than 700 rats, guinea pigs, rabbits, minipigs, and 200 burns patient were used to compare early feeding (EF) with delayed feeding (DF). Placing emphasis on 21 cases of severe burns (32.8 ± 10.9 years, total body surface area burned (TBSAB) 45 ± 12.6 %, deep burn 29.8 ± 8.9 %) in 200 burn patients. Feeding was started within PBH 2 (2 h post-burn, in animals) or PBH 12 (patients) in the EF group and after PBH 48 (animal) or PBH 72 (patient) in the DF group. In addition, we created three animal models to study the effect and mechanism of early feeding. 1. The model of gastrostomy and neglecting jejunum in burn rabbit) The jejunum is cut off 5 cm under the ligament of Treitz, close to the distal end of the cut jejunum, end-toside anastomosis between the upper end and the side under the distal end 15 cm from the cut jejunum. The intestine up to 15 cm of anastomotic stoma is the neglecting jejunum; several interrupted sutures are performed just above the anastomotic stoma to form an artifi cial valve to prevent food regurgitation into the neglected jejunum. This model is used to study the effect of early feeding post-burn on protecting intestinal mucosa and the mechanism (Fig. 16.1 ). 2. The model of gastrostomy and central vein, portal vein, and mesenteric vein catheterization in Gui-zhou mini-pigs). This model is used to investigate the effect and its mechanism of early feeding on central and portal vein blood fl ow, intestinal absorption function, barrier function of the intestinal mucosa, and hypermetabolism ( Fig. 16.2 ). 3. The model of gastrostomy and central vein, portal vein, mesenteric vein, iliac vein, and artery catheterization in Gui-zhou mini-pigs One the basis of the model ( Fig. 16.2 ), this mode is used to further study the protection effect of early feeding and glutamine on intestinal structure and function, and understanding substance metabolic changes of muscle in the lower extremities (Fig. 16.3 ). Creation of Three Animal Early Feeding Could Lessen IntestinalAnoxia Injury and Promote Intestine Resuscitation [ 4 -22 ] Early feeding (EF) post-burn could improve portal and intestinal blood fl ow, lessen intestinal ischemia and reperfusion injury, provide better energy metabolism of intestinal mucosa cells, lower depression of mucosa proliferation and reparation, and maintain the intestinal structure and function. 1. Early feeding could lessen intestinal ischemia and anoxia injury (Tables 16.1 , 16.2 , 16.3 , 16.4 , 16.5 , 16.6 , 16.7 , 16.8 , and 16.9 ) Early feeding could improve portal and intestinal blood fl ow and lessen intestinal ischemia and reperfusion injur...

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“…Five trials investigated the effect of arginine supplementation in patients with burn injury (Table 3), [31][32][33][34][35] and three studies are represented in abstract only. [33][34][35] Marin et al 31 reported the effect of arginine supplementation on immunologic and metabolic status.…”

Section: Argininementioning

confidence: 99%

“…[33][34][35] Marin et al 31 reported the effect of arginine supplementation on immunologic and metabolic status. This was the only double-blinded, randomized, controlled trial identified and provided the longest supplementation period and the only reported effect on length of stay.…”

Section: Argininementioning

confidence: 99%

The Use of Immunonutrition in Burn Injury Care: Where Are We?

Kurmis

Parker

Greenwood

2010

Journal of Burn Care & Research

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The aim of this study is to review the current evidence for immunonutrition use in patients with burn injury. Nutrients of interest included glutamine, arginine, and omega-3 fatty acids (fish oil). A literature review was conducted to identify studies that evaluated the use of immunonutrients in pediatric and adult patients with burn injury. Search terms included burns, immunonutrition, pharmaconutrition, glutamine, arginine, omega-3, and fish oil. Glutamine: Nine randomized controlled trials (four represented in abstract only) investigating enteral supplementation and two trials investigating parenteral supplementation of glutamine were identified. Arginine: Five trials investigating the effect of arginine supplementation were identified (three represented in abstract only). Omega-3 fatty acids: Three studies investigating the effect of enteral fish oil supplementation were identified (one represented in abstract only). Combined immunonutrients: Six studies were identified that investigated immunonutrients as a combination of active dietary constituents (rather than as individual nutrients). Despite the semiessential nature of arginine after burn injury, there were surprisingly little data regarding nutritional supplementation. Literature around supplementation of omega-3 fatty acids is found to be lacking in the burn injury population. The combination of immunonutrients as a component of enteral formulae limits identification of the active nutrient and ideal dosage. Current evidence supports the use of enteral glutamine supplementation for patients with severe burn injuries. Questions remain regarding dosage, timing, and length of supplementation.

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Effect of Arginine Supplementation on T-Lymphocyte Function in Burn Patients

Cited by 3 publications

References 0 publications

Metabolism in Burns

Metabolism in Burns

Nutrition in Burns

The Use of Immunonutrition in Burn Injury Care: Where Are We?

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