Immunonutrition and critical illness: an update.
Dietary supplementation with nutrients that have physiologic effects on immune function has been shown to be beneficial in subsets of patients with surgical and medical critical illness. However, several meta-analyses have suggested potential harm when immune nutrients are used inappropriately. This has led to concern among clinicians that in turn has curtailed the more widespread use of immunonutrition as a therapeutic modality. This article discusses the mechanisms by which immune nutrients can be used to modulate alterations in innate and acquired immunity associated with critical illness. In addition, recent evidence-based clinical practice guidelines for use of immunonutrition in adults is reviewed as a means to clarify some of the more controversial issues and provide a "roadmap" for the practitioner.
Mizock
Barry A
BA
Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA. bmizock@earthlink.net
D000975:Antioxidants / Q000494:pharmacology / Q000627:therapeutic use; D001120:Arginine / Q000494:pharmacology / Q000627:therapeutic use; D016638:Critical Illness; D019587:Dietary Supplements; D005227:Fatty Acids / Q000494:pharmacology / Q000627:therapeutic use; D005973:Glutamine / Q000494:pharmacology / Q000627:therapeutic use; D017408:Guidelines as Topic; D006801:Humans; D007109:Immunity / Q000187:drug effects*; D007155:Immunologic Factors / Q000494:pharmacology / Q000627:therapeutic use*; D018977:Micronutrients / Q000494:pharmacology / Q000627:therapeutic use*
D000975:Antioxidants; D005227:Fatty Acids; D007155:Immunologic Factors; D018977:Micronutrients; D005973:Glutamine; D001120:Arginine