Randomized Trial to Evaluate Nutritional Status and Absorption of Enteral Feeding after Brain Death

Abstract

Context Catecholamines and inflammatory mediators, with elevated levels after brain death, are associated with reduced function and survival of transplanted organs. Enteral nutrition reduces tissue damage and may benefit organs. Objective To evaluate the effects of immunomodulating enteral nutrition in organ donors. Design Prospective, randomized, open-label study. Setting Intensive care unit. Patients Thirty-six brain-dead organ donors. Interventions Donors were randomized to receive enteral nutrition containing omega-3 polyunsaturated fatty acid, antioxidants, and glutamine or standard care (fasting). Donors received hormonal replacement therapy of corticosteroid, levothyroxine, dextrose, and insulin. Main Outcome Measures Gastrointestinal assimilation (measured by 13carbon-labeled uracil breath analysis), quantity of organs recovered, resting energy expenditure, urine level of urea nitrogen, and serum levels of albumin, prealbumin, interleukin 6, tumor necrosis factor-α, and C-reactive protein were evaluated. Results Thirteen patients (36%) assimilated 13C-labeled uracil. Resting energy expenditure was significantly higher than predicted between 10 and 14 hours after baseline in 33 donors (P = .007). Other measures were not conclusively different between fed and fasting groups. No adverse events occurred that were related to the enteral feeding. Conclusions About 30% of donors metabolized 13C-labeled uracil, although no difference in oxidation rate was found between fasting and fed donors. Corticosteroid administration lowers plasma levels of interleukin 6 and most likely contributes to greater than predicted resting energy expenditure. Thus energy needs may not be met during fasting if hormones are given. Consequences of this possible energy deficit warrant further study.

Association between artificial nutrition in brain dead donors and early allograft function in liver transplant recipients: an observational study

“…The outcomes (defined as recipient alive, dead or in need of retransplantation) for organs from enterally or parenterally fed donors did not differ significantly from those for organs acquired from starving donors; however, early and late allograft function were not investigated. 14 Our data support a possible positive effect of nutrition on early The goal of this study was to shed some light onto this difficult and new field of study.…”

“…The donor's theoretical caloric needs were assessed using the Harris-Benedict equation (Basal Metabolic rate [BMR]) corrected for the 1.2 coefficient, as reported in other studies in the literature. 14 The formula can be entirely reprised as:…”

Relationships Between Resting Energy Expenditure and Transcranial Doppler Measurements in Patients With and Without Brain Death

“…Moreover, the decrease in REE as patients deteriorate to BD has been attributed to hypothermia, while the core temperature influences the REE values [ 10 ]. Albeit, earlier investigations showed a higher than predicted REE in brain-dead patients, suggesting that energy expenditure requirements may not be met in fasting donors awaiting organ removal [ 17 ].…”

Variability in deceased donor care in Canada: a report of the Canada-DONATE cohort study

“…A recent multicentre randomized trial also supports mild therapeutic hypothermia (core temperature 34-35°C) for NDD donors, who achieved better post-transplant kidney function 10 ; however, less than 10% of NDD donors in this cohort had a final core temperature in that range. Based on much weaker evidence, enteral feeding is a suggested consideration for NDD donors, 21 but this practice varied considerably across provinces. Previous Canadian guidelines did not address these three donor treatments, which may benefit from targeted knowledge translation initiatives.…”