Immunonutrition in septic patients: a philosophical view of the current situation.
OBJECTIVE
Two different ways of thinking pervaded the history of science: rationalism and empiricism. In theory, these two paradigms are not necessarily in conflict. In practice, there has always been tension between them. The coming of evidence-based medicine put empiricism in a privileged position, but empiricism without a rationalistic guide could even be usefulness. The aim of this work is to present the tension between the rational reasons to administer immunonutrients to patients with sepsis and the controversial empirical evidence stemming from clinical trials.


METHODS
We reviewed the literature on immunonutrition in sepsis from the rationalist and the empiricist perspectives.


RESULTS
The large body of evidence for positive effects of immunonutrients in experimental models and the contradictory results from clinical trials make the discussion on immunonutrition in sepsis a typical example where the conflict between rationalism and empiricism hampered the advancement of knowledge and the implementation of new effective therapies into clinical practice.


CONCLUSIONS
Future research projects involving immunonutrients should be based on robust knowledge of basic mechanisms of action to be properly addressed in clinical trials.
Bertolini
Guido
G
Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva Coordinating Center-Laboratory of Clinical Epidemiology, Mario Negri Institute for Pharmacological Research, Aldo e Cele Daccò, Ranica (Bergamo), Italy. bertolini@marionegri.it
Luciani
Davide
D
Biolo
Gianni
G
D019317:Evidence-Based Medicine; D006801:Humans; D009747:Nutritional Physiological Phenomena; D018529:Nutritional Support; D018805:Sepsis / Q000276:immunology* / Q000628:therapy*; D016896:Treatment Outcome