Effect of Preoperative Administration of Oral Arginine and Glutamine in Patients with Enterocutaneous Fistula Submitted to Definitive Surgery: a Prospective Randomized Trial

Martínez, José Manuel Lavié; Boscó-Gárate, Ilka; Souza-Gallardo, Luis Manuel; Méndez, José D.; Juárez-Oropeza, Marco Antonio; Román-Ramos, Rubén; Ferat‐Osorio, Eduardo

doi:10.1007/s11605-018-04099-4

Cited by 8 publications

(15 citation statements)

References 41 publications

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“…The characteristics of the included studies by type of intervention, aggregate data from the included studies by type of intervention, RoB assessment, summary of findings, excluded studies, studies that fit the inclusion criteria but had no usable data, and relevant protocols of ongoing or unpublished studies are shown in the online supplemental digital content. We identified eight types of interventions administered in the preoperative period: nutritional (51 studies),30–80 respiratory (30 interventions of 29 studies)81–109 exercise (27 studies),110–136 multimodal (25 studies),100 108 137–159 educational (17 studies),160–176 psychological (16 studies),177–192 smoking and alcohol cessation (7 studies)193–199 and pharmacological (5 studies)200–204 (table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Nutritional interventions were further subdivided into standard oral nutritional supplements (ONS, 7 studies),30–35 69 oral immunonutrition supplements (19 studies)36–47 70–75 80 weight loss interventions (11 studies),48–51 53–57 76 205 oral prebiotics and probiotics (6 studies),58–61 77 78 dietary optimisation of comorbidities (3 studies)62–64 and other (5 studies, generally including administration of nutritional supplements such as fish oils, antioxidants, etc) 65–68 79. Respiratory interventions were further subdivided into IMT (18 studies),81–95 106 108 109 IS (5 studies)90 96–99 and combined respiratory interventions (7 studies, involving combinations of IMT, IS, other respiratory exercises and physical exercises) 100–105 107…”

Section: Resultsmentioning

confidence: 99%

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Pre-admission interventions (prehabilitation) to improve outcome after major elective surgery: a systematic review and meta-analysis

et al. 2021

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ObjectiveTo determine the benefits and harms of pre-admission interventions (prehabilitation) on postoperative outcomes in patients undergoing major elective surgery.DesignSystematic review and meta-analysis of randomised controlled trials (RCTs) (published or unpublished). We searched Medline, Embase, CENTRAL, DARE, HTA and NHS EED, The Cochrane Library, CINAHL, PsychINFO and ISI Web of Science (June 2020).SettingSecondary care.ParticipantsPatients (≥18 years) undergoing major elective surgery (curative or palliative).InterventionsAny intervention administered in the preoperative period with the aim of improving postoperative outcomes.Outcomes and measuresPrimary outcomes were 30-day mortality, hospital length of stay (LoS) and postoperative complications. Secondary outcomes included LoS in intensive care unit or high dependency unit, perioperative morbidity, hospital readmission, postoperative pain, heath-related quality of life, outcomes specific to the intervention, intervention-specific adverse events and resource use.Review methodsTwo authors independently extracted data from eligible RCTs and assessed risk of bias and the certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation. Random-effects meta-analyses were used to pool data across trials.Results178 RCTs including eight types of intervention were included. Inspiratory muscle training (IMT), immunonutrition and multimodal interventions reduced hospital LoS (mean difference vs usual care: −1.81 days, 95% CI −2.31 to −1.31; −2.11 days, 95% CI −3.07 to −1.15; −1.67 days, 95% CI −2.31 to −1.03, respectively). Immunonutrition reduced infective complications (risk ratio (RR) 0.64 95% CI 0.40 to 1.01) and IMT, and exercise reduced postoperative pulmonary complications (RR 0.55, 95% CI 0.38 to 0.80, and RR 0.54, 95% CI 0.39 to 0.75, respectively). Smoking cessation interventions reduced wound infections (RR 0.28, 95% CI 0.12 to 0.64).ConclusionsSome prehabilitation interventions may reduce postoperative LoS and complications but the quality of the evidence was low.PROSPERO registration numberCRD42015019191.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Pre-admission interventions (prehabilitation) to improve outcome after major elective surgery: a systematic review and meta-analysis

et al. 2021

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“…Nevertheless, glutamine metabolism will not be optimal in individuals with kidney, liver, or sepsis failure, since they have a higher risk of toxicity. 11 According to a study by Martinez et al 21 , enteral administration of 4.5 g of arginine and 10 g of glutamine in a preoperative ECF patient for seven days can reduce the recurrence risk and the inflammatory cytokines for one week postoperatively. Other immunonutrient supplements such as arginine, omega-3 fatty acids, and nucleotides have yet to be proven in ECF cases.…”

Section: Specific Nutrientsmentioning

confidence: 99%

Medical Nutrition Therapy In Enterocutaneous Fistula: A Step-By-Step Approach

Nathania

Andayani

2021

World Nutr J

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Enterocutaneous fistula (ECF) management is a challenge that requires a multidisciplinary team approach in achieving optimal clinical output. Nutrition as a component of management plays a vital role in determining the prognosis, both as a predictor of morbidity and mortality. Malnutrition can also occurs as a preceeding situation or complication of ECF caused by the underlying disease, decreased food intake, increased protein requirements associated with systemic inflammation, and increased nutrient loss associated with the amount of fistula output. Thus, nutrition management can act as prevention, therapy, or both. Nutritional medical therapy in ECF cases aims to adequately estimate nutritional needs, maintain fluid and electrolyte balance, and stimulate spontaneous ECF closure whenever possible. To achieve optimal outcome, nutrition needs analysis must be done individually by considering the etiology, anatomical location of the fistula, and the amount of output. In the following article, we will discuss a comprehensive step-by-step nutrition treatment, both from the nutritional routes consideration, macronutrient and micronutrient requirements, specific nutrients, pharmacotherapy, and monitoring and evaluation that need to be done to achieve optimal clinical outcomes.

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“…However, glutamine supplementation in either PN or EN is a controversial topic. Martinez et al ( 43 ) suggests that oral administration of arginine and glutamine supplementation 1 week prior to surgery may be beneficial for patients undergoing final surgery.…”

Section: En and Ecfmentioning

confidence: 99%

Nutritional Management of Patients With Enterocutaneous Fistulas: Practice and Progression

et al. 2020

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The management of enterocutaneous fistulas (ECF) can be challenging because of massive fluid loss, which can lead to electrolyte imbalance, severe dehydration, malnutrition and sepsis. Nutritional support plays a key role in the management and successful closure of ECF. The principle of nutritional support for patients with ECF should be giving enteral nutrition (EN) priority, supplemented by parenteral nutrition if necessary. Although total parenteral nutrition (TPN) may be indicated, use of enteral feeding should be advocated as early as possible if patients are tolerant to it, which can protect gut mucosal barrier and prevent bacterial translocation. A variety of methods of enteral nutrition have been developed such as fistuloclysis and relay perfusion. ECF can also be occluded by special devices and then EN can be implemented, including fibrin glue application, Over-The-Scope Clip placement and three-dimensional (3D)-printed patient-personalized fistula stent implantation. However, those above should not be conducted in acute fistulas, because tissues are edematous and perforation could easily occur.

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Effect of Preoperative Administration of Oral Arginine and Glutamine in Patients with Enterocutaneous Fistula Submitted to Definitive Surgery: a Prospective Randomized Trial

Cited by 8 publications

References 41 publications

Pre-admission interventions (prehabilitation) to improve outcome after major elective surgery: a systematic review and meta-analysis

Pre-admission interventions (prehabilitation) to improve outcome after major elective surgery: a systematic review and meta-analysis

Medical Nutrition Therapy In Enterocutaneous Fistula: A Step-By-Step Approach

Nutritional Management of Patients With Enterocutaneous Fistulas: Practice and Progression

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