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Current Literature: Immunonutrition in the Critically Ill: A Systematic Review of Clinical Outcome
Author(s) -
Beale RJ,
Bryg DJ,
Bihari DJ
Publication year - 2000
Publication title -
nutrition in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.725
H-Index - 71
eISSN - 1941-2452
pISSN - 0884-5336
DOI - 10.1177/088453360001500609
Subject(s) - medicine , parenteral nutrition , enteral administration , relative risk , randomized controlled trial , confidence interval , sepsis , intensive care unit , medline , intensive care medicine , calorie , political science , law
Objective: To perform a meta‐analysis addressing whether enteral nutrition with immune‐enhancing feeds benefits critically ill patients after trauma, sepsis, or major surgery. Data Sources: Studies were identified by MEDLINE search (1967 to January 1998) for original articles in English using the search terms “human,” “enteral nutrition,” “arginine,” “nucleotides,” “omega‐3 fatty acids,” “immunonutrition,” “IMPACT,” and “Immun‐Aid.” Additionally, the authors of the studies and the manufacturers of the feedings were contacted for addition Information. Access to original databases was obtained for the three largest studies. Study Selection: Fifteen randomized controlled trials comparing patients receiving standard enteral nutrition with patients receiving a commercially available immune‐enhancing feed with arginine with or without glutamine, nucleotides, and omega‐3 fatty acids ? were identified by two independent reviewers (Dr. Beale and Dr. Bryg). Data Extraction: Descriptive and outcome data were extracted independently from the papers by the same two reviewers, one of whom (Dr. Bryg) analyzed the original databases. Three studies were excluded from analysis, leaving 12 studies containing 1557 subjects, 1482 of whom were analyzed. Main outcome measures were mortality, infection, ventilator days, intensive care unit stay, hospital stay, diarrhea days, calorie intake, and nitrogen intake. The meta analysis was performed on an intent‐to‐treat basis. Data Synthesis: There was no effect of immunonutrition on mortality (relative risk = 1.05, confidence interval [CI] = 0.78, 1.41; p = .76). There were significant reductions in infection rate (relative risk = 0.67, CI = 0.50,0.89; p = .006), ventilator days (2.6 days, CI = 0.1, 5.1; p = .04), and hospital length of stay (2.9 days, CI = 1.4, 4.4; p = .0002) in the immunonutrition group. Conclusions: The benefits of enteral immunonutrition were most pronounced in surgical patients, although they were present in all groups. The reduction in hospital length of stay and infections has resource implications. (Crit Care Med 27:2799–805, 1999)