Immunonutrition in fast-track surgical patients — evidence review and adapted algorithm

Candela, Carmen Gómez; Milla, Samara Palma; Lozano, Elena Carrillo; Martino, Marcello Di; Alcolea, Natalia González; Roldán, Juana Olivar; Suárez-de-la-Rica, Alejandro; Lagunas, David Pestaña

doi:10.20960/nh.03405

Cited by 3 publications

(4 citation statements)

References 51 publications

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“…The increase in evidence regarding the use of these formulas for this type of patients has resulted in clinical guidelines recommending their use in upper digestive tract surgery [ 2 ]. Nevertheless, their use in an ERAS protocol is not yet fully recommended due to a lack of evidence in studies that included these protocols [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of Immunonutrition on Cancer Patients Undergoing Surgery: A Scoping Review

et al. 2023

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Introduction: There is a large body of evidence about immunonutrition formulas; however, there are still doubts about their usefulness in routine clinical practice as compared with standard formulas. In the age of personalized medicine, new studies appear every year regarding several types of patients; therefore, an updated point of view on these formulas is necessary. Methods: The Embase database was searched from 2016 to 14 March 2022. Our criteria were articles published in English and Spanish. The evidence quality was evaluated using GRADEpro, and the review was developed according to the PRISMA statement. Results: In this review, a total of 65 unique records were retrieved; however, 36 articles did not meet the inclusion criteria and were thus excluded. In total, 29 articles were included in the final analysis. In the last few years, many meta-analyses have attempted to identify additional existing studies of surgical patients with certain pathologies, mainly oncological patients. Immunonutrition prior to oncological surgery was shown to cause a decrease in inflammatory markers in most of the studies, and the main clinical events that changed were the infectious complications after surgery. The length of stay and mortality data are controversial due to the specific risk factors associated with these events. Conclusions: The use of immunonutrition in patients who have undergone oncological surgery decreases the levels of inflammatory markers and infectious postoperative complications in almost all localizations. However, more studies are needed to assess the use of immunonutrition based on Enhanced Recovery After Surgery (ERAS) protocols.

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Section: Discussionmentioning

confidence: 99%

Effects of Immunonutrition on Cancer Patients Undergoing Surgery: A Scoping Review

et al. 2023

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“…Most of the patients reported in the case reports were previously healthy, including 3 adult women and 7-year-olds. In contrast, the reported patient’s immunity level was low at the time of hospitalization after cardiac surgery, which might be due to cardiac surgery injury, CPB, blood loss and malnutrition ( Angele and Faist, 2002 ; Gaudriot et al., 2015 ; Candela et al., 2021 ). A previous study showed that the bactericidal activity of neutrophil bactericidal agents against Staphylococcus aureus was decreased after cardiac surgery ( Mekontso-Dessap et al., 2005 ).…”

Section: Discussionmentioning

confidence: 92%

First report on severe septic shock associated with human Parvovirus B19 infection after cardiac surgery

Xiang

Wei

et al. 2023

Front. Cell. Infect. Microbiol.

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BackgroundHuman Parvovirus B19 (PB19) is a single-stranded DNA virus. Septic shock from viremia is rare with PB19; however, this infection can progress to life-threatening conditions. We report the first case of severe septic shock associated with a PB19 infection after cardiac surgery.Case PresentationA 50-year-old Chinese woman received elective double metal valve replacement, including the aortic valve and the mitral valve, under cardiopulmonary bypass (CPB) and suffered severe septic shock on postoperative day (PD) 30. Through the detection of PB19-specific nucleic acids in blister fluid and serum samples via metagenomic next-generation sequencing (mNGS), positive serum PB19 IgM and no other proven infection, acute PB19 infection was confirmed. After five days of combined treatment, no further fever or abdominal discomfort was noted, and the patient’s circulation gradually became stable without vasoactive medications.ConclusionPB19 may be an unrecognized cause of septic shock, rash, fever of unknown origin or multiple systemic signs and symptoms, especially in immunosuppressed and immunocompetent critically ill patients. Investigations for viral aetiology are needed.

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“…Es importante la arginina en pacientes críticos y en estado de estrés. Por ende, el fundamento metabólico y fisiopatológico (Anexo 7) de este inmunonutriente suplementado en el paciente oncológico post operado es promover rápidamente la cicatrización de las heridas en después del acto quirúrgico, esto se realizaría a través de mecanismo de síntesis de prolina y colágeno evitando así complicaciones post operatorias infecciosas a causa de retraso de la cicatrización de la herida post operatoria (51).…”

Section: B3 Aplicación Clínica Quirúrgicaunclassified

“…El fundamento metabólico y fisiopatológico (Anexo 6) de este inmunonutriente enteral suplementado en el paciente oncológico post operado es atenuar la producción de las prostaglandinas inflamatorias y prostaciclinas, esto puede darse debido a que la suplementación con el ácido graso eicosapentaenoico (EPA) regula la función inmunitaria, regula la producción de los radicales libres y promueve el metabolismo de los eicosanoides, favoreciendo al estado inflamatorio, reduciendo e inhibiendo los transportadores de células inflamatorias y mediadores en el sitio de la injuria, por ende así evitaría las complicaciones post operatorias infecciosas (neumonía, infección del sitio operatoria, complicaciones en la cicatrización de la herida post operatoria) , alteraciones de la respuesta inflamatoria con relación a los marcadores bioquímicos (TNF-α y las interleucinas) y disminuiría la estancia hospitalaria (44,51).…”

Section: C2 Aplicación Clínica Quirúrgicaunclassified

Efecto de la inmunonutrición enteral como estrategia nutricional en pacientes oncológicos hospitalizados sometidos a cirugías mayores gastrointestinales: Revisión sistemática y metaanálisis

Recoba Obregon

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El paciente oncológico con tratamiento quirúrgico gástrico o de colon con desnutrición, pueden presentar alteraciones con respeto a la respuesta inflamatoria y complicaciones post operatorias. El objetivo de este estudio fue evaluar, a partir de una revisión sistemática con metaanálisis, el efecto de la inmunonutrición enteral (arginina, glutamina, omega 3 y nucleótidos) como estrategia nutricional en pacientes oncológicos hospitalizados sometidos a cirugías mayores gastrointestinales para la disminuir las complicaciones post operatorias y modificar los cambios en la respuesta inflamatoria. Se revisó la literatura tanto en español, inglés y portugués para recolectar la información registrada en las bases de datos Medline a través de Ovid, Cochrane (Central), Scopus, Web of Science y EMBASE. Adicionalmente se realizó la búsqueda en los motores como Google Académico y Trip Data Base. Se detectaron 1236 artículos relacionados al tema, de los cuales se seleccionaron 18 ensayos clínicos aleatorizados (ECA) internacionales (5,5 % desarrollados en América, 50 % en Asia y 44,5 % en Europa). Esta selección se basó en los criterios de inclusión-exclusión, y mediante la metodología de la herramienta Cochrane, para la clasificación de la calidad de la evidencia en la tabla de resumen y graduación de la fuerza de recomendación se utilizó el sistema GRADE. Por lo tanto, los criterios de selección de la literatura para este estudio, permitieron identificar un nivel de certeza baja y fuerza de recomendación fuerte para los resultados de complicaciones post operatorias por infecciones (RR 0.74 IC 95%; 0.60-0.90, p=0.003; I2=12%) para el tratamiento con inmunonutrición enteral, aplicada a pacientes con cáncer gástrico y colon. Este resultado avala el efecto favorable de la inmunonutrición enteral en el manejo de las complicaciones post operatorias infecciosas en el paciente oncológico con cirugías mayores gastrointestinales.

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Immunonutrition in fast-track surgical patients — evidence review and adapted algorithm

Cited by 3 publications

References 51 publications

Effects of Immunonutrition on Cancer Patients Undergoing Surgery: A Scoping Review

Effects of Immunonutrition on Cancer Patients Undergoing Surgery: A Scoping Review

First report on severe septic shock associated with human Parvovirus B19 infection after cardiac surgery

Efecto de la inmunonutrición enteral como estrategia nutricional en pacientes oncológicos hospitalizados sometidos a cirugías mayores gastrointestinales: Revisión sistemática y metaanálisis

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