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The effect of enteral and perenteral nutrition on blood and respiratory tract immunoglobulins in intensive care unit patients

Aims

The immunoglobulin production is influenced by the functional integrity of the intestinal mucosa, as long as 50% of the secretory IgA originates from it. Therefore, the type of nutritional schedule could interfere with immune response of the respiratory tract. The aim of our study was to compare the changes of the immunoglobulins (IgA, IgG and IgM) in the blood and the bronchial secretions in intensive care unit (ICU) patients under enteral (EN) and total parenteral (TPN) nutrition.

Methods

Twenty ICU patients were included in the study. Ten of them received EN and the other 10 TPN. Immunoglobulins (IgA, IgG and IgM) were measured in the blood and the bronchial secretions (samples obtained during bronchoscopy), at the 1st and 5th hospitalization day. White blood cells were also measured and cultures of bronchial secretions were received.

Results

Our results concerning immunoglobulins levels on the 1st and 5th day (mean values ± SD) are presented in the following table (mg/dl).

Table 1 Table

During the 1st day of the study immunoglobulins did not differ significantly either in blood or in bronchial secretions in both groups.

During the 5th day of the study we did not detect significantly differences (P > 0.05) for immunoglobulins in the blood in both groups. We detected significantly differences (P > 0.05) of immunoglobulins in bronchial secretions between EN and TPN.

Between 1st and 5th day in EN group, there are not significantly differences for immunoglobulins either in blood or in bronchial secretions.

Between 1st and 5th day in TPN group, there are not significantly differences for immunoglobulins in blood, but there are significantly differences for IgA and IgG in bronchial secretions.

Conclusions

The TPN results in atrophy of intestine mucosa and, therefore in deficiency of the gut associated lymphoid tissue, which would explain the decrease of respiratory tract immunoglobulins.

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Moukas, M., Mandragos, K., Schulpis, K. et al. The effect of enteral and perenteral nutrition on blood and respiratory tract immunoglobulins in intensive care unit patients. Crit Care 5, P131 (2001). https://doi.org/10.1186/cc1198

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Keywords

  • Immune Response
  • Intensive Care Unit
  • Respiratory Tract
  • White Blood Cell
  • Emergency Medicine