Immunonutrition in the critically ill: from old approaches to new paradigms

Excerpt

In this issue of Intensive Care Medicine, Keift et al. [1] report the results of a multicenter, randomized, double-blind, controlled trial comparing an enteral formula enriched with arginine, glutamine, antioxidants and containing omega 3 fatty acids with an isocaloric, non-isonitrogenous standard enteral formula, in a mixed population of 597 critically ill patients. When analyzed both using an efficacy analysis (those fed for more than 48 h) and by an intention-to-treat analysis, the authors failed to demonstrate any difference in clinical outcomes in the overall analysis or several subgroup analyses. Mortality, infectious complications, ICU length of stay, and duration of mechanical ventilation were the same between the two groups. Although the lack of a treatment effect on clinical outcomes has been shown in other trials, given the highly controversial nature of the topic of immunonutrition in critically ill patients, this article is significant, particularly since this is the largest and one of the more robust randomized trials of immune-enhancing diets in an ICU population. …