Effect of recombinant human insulin-like growth factor I and early total parenteral nutrition on immune depression following severe head injury
| Autor: | Daniel L. Dent, Timothy C. Fabian, Julie G. Bukar, Rex O. Brown, Kenneth A. Kudsk, Christine A. Mowatt-Larssen, Sherryl Oellerich |
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| Rok vydání: | 1994 |
| Předmět: |
Adult
Male medicine.medical_specialty Resuscitation medicine.medical_treatment CD4-CD8 Ratio law.invention Leukocyte Count Randomized controlled trial law Fracture fixation medicine Craniocerebral Trauma Humans Lymphocytes Insulin-Like Growth Factor I Saline business.industry Head injury Trauma center Glasgow Coma Scale medicine.disease Recombinant Proteins Surgery Parenteral nutrition Anesthesia Female Parenteral Nutrition Total business |
| Zdroj: | Archives of surgery (Chicago, Ill. : 1960). 129(1) |
| ISSN: | 0004-0010 |
| Popis: | Objective: To determine the effects of insulin-like growth factor I (IGF-I) and aggressive nutrition on CD4/CD8 ratios following head injury. Design: Randomized controlled trial. Setting: An urban level 1 trauma center. Participants: Head-injured patients with a Glasgow Coma Scale score of 4 to 10 within 6 hours of hospital admission requiring no major extracranial surgery with the exception of isolated lower-extremity fracture fixation. Fourteen patients were recruited and 11 completed the study. Interventions: Patients were randomized to a continuous infusion of saline or 0.01 mg/kg per hour of recombinant human (rh) IGF-I. Both groups received parenteral nutrition and rapidly advanced to a total protein intake of 2 g/kg per day and a maximum nonprotein calorie intake of 40 kcal/kg per day. The nonprotein prescription was 1.25 times the metabolic energy expenditure determined by metabolic cart not to exceed a nonprotein calorie intake of 40/kcal. Main Outcome Measures: The CD4/CD8 ratios and serum IGF-I levels on days 1, 7, and 14. Results: Administration of early aggressive nutrition eliminated the depressed CD4/CD8 ratio usually seen after head injury; administration of IGF-I increased the CD4/CD8 ratio while IGF-I levels were elevated. Conclusions: Infusion of rhIGF-I and aggressive early intravenous nutrition affects the immunologic response of patients with severe head injury. (Arch Surg. 1994;129:66-71) |
| Databáze: | OpenAIRE |
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