An immune-enhancing nutritional supplement conventionally used in critical care and cancer surgery could be beneficial for elderly and other high-risk patients requiring cardiac surgery, conclude authors of a study in this week’s issue of THE LANCET.
Elderly patients and those with poor ventricular function have increased illness and death rates when undergoing cardiac surgery. Robert Tepaske and colleagues from the University of Amsterdam, Netherlands, assessed whether an oral immune-enhancing nutritional supplement could improve patients’ preoperative immune defence, and subsequently lower rates of postoperative infections and organ dysfunction in patients undergoing elective cardiac surgery.
In a prospective, randomised study, 50 patients were given either an oral immune-enhancing nutritional supplement (containing L-arginine, þ3 polyunsaturated fatty acids, and yeast RNA) or placebo for a minimum of five days before coronary artery bypass. Patients were included if they were aged 70 years or older, or if they had a left-ventricular ejection fraction of less than 0.4, or were scheduled to undergo mitral-valve replacement.
Patients given the nutritional supplement had improved preoperative host defence, fewer patients had postoperative infections (4 patients compared with 12 in the control group), and they had better preserved renal function compared with patients given placebo. The investigators conclude that their study supports the use of an oral immune-enhancing nutritional supplement in patients who are undergoing cardiac surgery and are at high risk of infection.
Contact: Dr Robert Tepaske,Department of Intensive Care,Academic Medical Centre - University of Amsterdam, Meibergdreef 9,P.O.-box 22660, 1100 DD Amsterdam, Netherlands;T) +31 20 566 2509;F) +31 20 697 2988; E) r.tepaske@amc.uva.nl
The Lancet