An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients.
OBJECTIVE
To determine whether early enteral feeding in a septic intensive care unit (ICU) population, using a formula supplemented with arginine, mRNA, and omega-3 fatty acids from fish oil (Impact), improves clinical outcomes, when compared with a common use, high protein enteral feed without these nutrients.


METHODS
A prospective, randomized, multicentered trial.


METHODS
ICUs of six hospitals in Spain.


METHODS
One hundred eighty-one septic patients (122 males, 59 females) presenting for enteral nutrition in an ICU.


METHODS
Septic ICU patients with Acute Physiology and Chronic Health Evaluation (APACHE) II scores of > or =10 received either an enteral feed enriched with arginine, mRNA, and omega-3 fatty acids from fish oil (Impact), or a common use, high protein control feed (Precitene Hiperproteico).


RESULTS
One hundred seventy-six (89 Impact patients, 87 control subjects) were eligible for intention-to-treat analysis. The mortality rate was reduced for the treatment group compared with the control group (17 of 89 vs. 28 of 87; p < .05). Bacteremias were reduced in the treatment group (7 of 89 vs. 19 of 87; p = .01) as well as the number of patients with more than one nosocomial infection (5 of 89 vs. 17 of 87; p = .01). The benefit in mortality rate for the treatment group was more pronounced for patients with APACHE II scores between 10 and 15 (1 of 26 vs. 8 of 29; p = .02).


CONCLUSIONS
Immune-enhancing enteral nutrition resulted in a significant reduction in the mortality rate and infection rate in septic patients admitted to the ICU. These reductions were greater for patients with less severe illness.
Galbán
C
C
Complejo Hospitalario Universitario, Santiago de Compostela, La Coruña, Spain.
Montejo
J C
JC
Mesejo
A
A
Marco
P
P
Celaya
S
S
Sánchez-Segura
J M
JM
Farré
M
M
Bryg
D J
DJ
D018806:APACHE; D001120:Arginine / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D004750:Enteral Nutrition / Q000379:methods*; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D005260:Female; D005526:Food, Formulated; D006801:Humans; D007109:Immunity; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009711:Nucleotides / Q000627:therapeutic use; D011446:Prospective Studies; D018805:Sepsis / Q000178:diet therapy* / Q000276:immunology / Q000401:mortality; D013030:Spain / Q000453:epidemiology
D015525:Fatty Acids, Omega-3; D009711:Nucleotides; D001120:Arginine