Role of fiber diet formula in surgical critically ill septic patients

Introduction

Diarrhea commonly occurs in surgical critically ill septic patients who received broad-spectrum antibiotics. Some reports demonstrated that a fiber diet with prebiotic properties could decrease the risk of diarrhea in nonseptic patients. However, most reports excluded septic patients who received broad-spectrum antibiotics. The objective of this study was to compare risk of diarrhea and diarrhea score between fiber and nonfiber diets in surgical septic patients who received broad-spectrum antibiotics.

Methods

We conducted a prospective, randomized control, double-blind study on a general surgical ICU in a university hospital. The patients who received broad-spectrum antibiotics and no contraindication to enteral feeding were enrolled into two arms after informed consent. Allocation to intervention was randomized individually to receive fiber diet or nonfiber diet up to 14 days. Demographic data, disease severity, nutritional delivery and diarrhea score were recorded each day. Intention-to-treat analysis was performed after completed study.

Results

Thirty-four patients were enrolled in the study (17 patients each in the fiber group and the nonfiber group). These two patient groups were similar in demographics, disease severity, nutritional status, cause of sepsis and total feeding per day. Although the proportion of patients who confronted with diarrhea score >15 was higher in the nonfiber group than the fiber group, these did not show statistical difference significantly (8/17 patients (47.06%) vs 4/17 patients (23.53%); P = 0.15). However; the group of the fiber diet had a lower mean diarrhea score (fiber vs nonfiber = 3.6 ± 2.3 vs 6.3 ± 3.6; P = 0.005) and the generalized estimation equation model for repeated measurement (GEE) revealed a lower global diarrhea score in the fiber group than the nonfiber group about 3.03 (coefficient -3.03 (95% CI = -5.03 to -0.92); P = 0.005). Cox proportional hazard ratio of fiber group was 0.45 (95% CI = 0.13 to 1.49; P = 0.19) but no statistical difference.

Conclusions

Enteral nutrition with a fiber diet formula could reduce the diarrhea score in surgical critically ill septic patients who received broad-spectrum antibiotics.