M. Metcalfe

PP229 IMPLEMENTATION OF THE CURRENT PRE-OPERATIVE FASTING GUIDELINES, HAS IT BEEN SUCCESSFUL? AN AUDIT OF CURRENT PRACTICE

with less hypoglycemia (2% SPRINT vs 7.7% and 2.9% for Glucontrol-A,B). SPRINT had less BG 8.0mmol/L). Conclusion: Protocols that dose insulin “blind” to carbohydrate administration suffer greater glycemic variability, even if cohort-wide glycemic targets are met. TGC protocols must be explicitly designed to account for carbohydrate administration to minimise BG variability and thus mortality outcomes across cohorts and/or centres.

PP224 EVALUATION OF THE RATIO OF N-6 TO N-3 FATTY ACIDS AFTER INFUSION OF TOTAL PARENTERAL NUTRITION CONTAINING EICOSAPENTAENOIC ACID (EPA) AND DOCOSAHEXANOIC ACID (DHA): A RANDOMISED CONTROLLED STUDY

inflammation. Lipid emulsions produce high levels of arachodonic acid, which up-regulate the inflammatory cascade and production of pro-inflammatory eicosanoids and cytokines. n-3FAs have shown profound anti-inflammatory properties in vitro, in-vivo, and in clinical trials Methods: 20 patients were randomised to receive a 72 hour infusion of TPN (Nutriflex basal®, BBraun) compounded with (Lipidem® 20%, BBraun) or without (Lipofundin® MCT 20%, BBraun) eicosapentaenoic acid and docosahexaenoic acid. Circulating serum cytokine levels were measured at 9 time points from baseline to 2 hours post of TPN using ELISA. Analysis of mean percentage change from baseline performed using Wilcoxon signed rank test. Results: There was a significant increase in proinflammatory cytokines IL2, 6, 8, 13, EGF & TNFa (p 0.05) in response to TPN infusion in the control group. Mean percentage change of circulating serum cytokine levels over the 72 hour period of IL2, 6, 8, 13, EGF & TNFa were 35.4, 551.8, 32.7, 39.2, 154.9 & 36.9% respectively. Maximal changes occurred at 6 hours for IL2, 8, 13 & TNFa, and 66 hours for IL6 and EGF. EPA and DHA significantly ameliorate the increase in pro-inflammatory cytokines IL2, 6, 8, 13, EGF & TNFa (p = 0.018, 0.012, 0.043, 0.018, 0.008 & 0.018). In contrast n-3FAs addition does not affect levels of antiinflammatory cytokines IL4 and TGFb. Conclusion: The addition of n-3FAs to TPN appears to have a beneficial effect on the production of cytokines involved in the inflammatory response. In patients with uncontrolled or chronic inflammation who require TPN the addition of n-3FAs to TPN is likely to be beneficial in modulating additional inflammatory response that results from the infusion of parenteral lipid emulsions.