Immunonutrition in critically ill patients: a systematic review and analysis of the literature.
BACKGROUND
The role of immuno-modulating diets (IMDs) in critically ill patients is controversial.


OBJECTIVE
The goal of this meta-analysis was to determine the impact of IMD's on hospital mortality, nosocomial infections and length of stay (LOS) in critically ill patients. Outcome was stratified according to type of IMD and patient setting.


METHODS
MEDLINE, Embase, Cochrane Register of Controlled Trials.


METHODS
RCT's that compared the outcome of critically ill patients randomized to an IMD or a control diet.


RESULTS
Twenty-four studies (with a total of 3013 patients) were included in the meta-analysis; 12 studies included ICU patients, 5 burn patients and 7 trauma patients. Four of the studies used formulas supplemented with arginine, two with arginine and glutamine, nine with arginine and fish oil (FO), two with arginine, glutamine and FO, six with glutamine alone and three studies used a formula supplemented with FO alone. Overall IMD's had no effect on mortality or LOS, but reduced the number of infections (OR 0.63; 95% CI 0.47-0.86, P = 0.004, I(2) = 49%). Mortality, infections and LOS were significantly lower only in the ICU patients receiving the FO IMD (OR 0.42, 95% CI 0.26-0.68; OR 0.45, 95% CI 0.25-0.79 and WMD -6.28 days, 95% CI -9.92 to -2.64, respectively).


CONCLUSIONS
An IMD supplemented with FO improved the outcome of medical ICU patients (with SIRS/sepsis/ARDS). IMDs supplemented with arginine with/without additional glutamine or FO do not appear to offer an advantage over standard enteral formulas in ICU, trauma and burn patients.
Marik
Paul E
PE
Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA. paul.marik@jefferson.edu
Zaloga
Gary P
GP
D001120:Arginine / Q000008:administration & dosage; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D003428:Cross Infection / Q000453:epidemiology; D004750:Enteral Nutrition; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D005526:Food, Formulated; D005973:Glutamine / Q000008:administration & dosage; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic
D015525:Fatty Acids, Omega-3; D005973:Glutamine; D001120:Arginine