Exploring choices of early nutritional support for patients with sepsis based on changes in intestinal microecology.

Xiao-Juan Yang, Xiao-Hong Wang, Ming-Yue Yang, Hong-Yan Ren, Hui Chen, Xiao-Ya Zhang, Qin-Fu Liu, Ge Yang, Yi Yang, Xiao-Jun Yang

Journal: World journal of gastroenterology 2023;29(13):2034-2049

PMID: 37155528

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Plain Language Summary

Sepsis is a condition brought about by infection and results in organ dysfunction and gut microbiota imbalance. Nutrition plays a large part in recovery from sepsis, however it is unclear as to the optimal diet for gut microbial balance in individuals with sepsis. This randomised control trial of 30 individuals with sepsis aimed to determine the optimal delivery of nutrition for gut microbial health either through a gastric tube (TEN), through the jugular vein (TPN), or a mixture of the two modes (SPN). The results showed differences in gut microbiota composition between the different modes of nutrition. Enterococcus increased in TEN, Campylobacter decreased in TPN, and Dialister decreased in SPN groups. Fermentation products produced by gut microbiota also changed depending on the mode of nutrition, with the TEN group showing improvements amongst the most fermentation products. Individuals in the TEN group also showed improved immune system function alongside those in the SPN group. It was concluded that based upon improvements to the immune system and gut microbiota, TEN is the most suitable mode for nutrition in individuals with sepsis. This study could be used by healthcare professionals to understand that nutrition methods for individuals with sepsis aren’t equally effective and recovery may be faster if individuals receive nutrition through a gastric tube.

Abstract

[{"label":"BACKGROUND","text":"Sepsis exacerbates intestinal microecological disorders leading to poor prognosis. Proper modalities of nutritional support can improve nutrition, immunity, and intestinal microecology."},{"label":"AIM","text":"To identify the optimal modality of early nutritional support for patients with sepsis from the perspective of intestinal microecology."},{"label":"METHODS","text":"Thirty patients with sepsis admitted to the intensive care unit of the General Hospital of Ningxia Medical University, China, between 2019 and 2021 with indications for nutritional support, were randomly assigned to one of three different modalities of nutritional support for a total of 5 d: Total enteral nutrition (TEN group), total parenteral nutrition (TPN group), and supplemental parenteral nutrition (SPN group). Blood and stool specimens were collected before and after nutritional support, and changes in gut microbiota, short-chain fatty acids (SCFAs), and immune and nutritional indicators were detected and compared among the three groups."},{"label":"RESULTS","text":"In comparison with before nutritional support, the three groups after nutritional support presented: (1) Differences in the gut bacteria (Enterococcus increased in the TEN group, Campylobacter decreased in the TPN group, and Dialister decreased in the SPN group; all < 0.05); (2) different trends in SCFAs (the TEN group showed improvement except for Caproic acid, the TPN group showed improvement only for acetic and propionic acid, and the SPN group showed a decreasing trend); (3) significant improvement of the nutritional and immunological indicators in the TEN and SPN groups, while only immunoglobulin G improved in the TPN group (all < 0.05); and (4) a significant correlation was found between the gut bacteria, SCFAs, and nutritional and immunological indicators (all < 0.05)."},{"label":"CONCLUSION","text":"TEN is recommended as the preferred mode of early nutritional support in sepsis based on clinical nutritional and immunological indicators, as well as changes in intestinal microecology."},{"copyright":"\u00a9The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved."}]

Address: Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China.; School of Clinical Medicine, Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China.; Department of Emergency Medicine, Affiliated Hospital of Jining Medical University, Jining 272030, Shandong Province, China.; Shanghai Mobio Biomedical Technology Co., Ltd., Shanghai 201318, China.; Department of Critical Care Medicine, Southeast University School of Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China.; Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China. [email protected].

DOI: 10.3748/wjg.v29.i13.2034