Efficacy of nutritional pharmacology in surgical patients.
The present article reviews the current concepts of immune enhancement through nutritional support for the surgical patient as they are derived experimentally and clinically. Although the potential for altering outcome in surgical patients through nutritional enhancement exists, the authors caution against overzealous application of laboratory data in the clinical arena. Available clinical studies have, at best, only demonstrated modest benefits. It is appropriate that the current literature be critically reviewed to assess the efficacy of the agent(s) purported to be of clinical benefit. Although present reports of immune-enhancing nutrition regimens demonstrate no overwhelming benefits in the critically ill or immunocompromised patient, the pursuit of this science remains undaunted. Lessons learned from the past are leading to reinvestigations in the laboratory, as well as better designs of clinical trials that are free of distracting post-hoc analysis and performed clearly in an intention-to-treat manner.
Lin
E
E
Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903, USA.
Goncalves
J A
JA
Lowry
S F
SF
D000596:Amino Acids / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D004750:Enteral Nutrition; D019382:Human Growth Hormone / Q000627:therapeutic use; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000627:therapeutic use; D008055:Lipids / Q000008:administration & dosage; D009711:Nucleotides / Q000008:administration & dosage; D009747:Nutritional Physiological Phenomena / Q000502:physiology*; D018529:Nutritional Support; D010289:Parenteral Nutrition, Total; D011182:Postoperative Care
D000596:Amino Acids; D008055:Lipids; D009711:Nucleotides; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I