Immunonutrition in surgical and critically ill patients

Area of Science:

• Nutritional immunology
• Critical care medicine
• Inflammation research

Background:

• Surgery, trauma, and critical illness trigger excessive inflammation, leading to immunosuppression and increased infection risk (sepsis).
• Nutrients play a crucial role in modulating inflammatory and oxidative stress responses, supporting immune function during critical illness.

Purpose of the Study:

• To review the role of various nutrients in managing inflammatory and immune responses in surgical, injured, and critically ill patients.
• To evaluate the clinical efficacy and safety of specific immunonutrients and nutrient mixtures.

Main Methods:

• Review of experimental and clinical studies on nutrients such as glutamine, long-chain n-3 fatty acids, antioxidant vitamins, minerals, and nucleotides.
• Analysis of evidence for immunonutrient mixtures (including arginine, nucleotides, n-3 fatty acids) in surgical and critically ill populations.

Main Results:

• Glutamine shows good evidence for improving immune function and clinical outcomes in surgical/injured patients.
• Long-chain n-3 fatty acids show promise but require more clinical efficacy data.
• Antioxidant vitamin/mineral mixtures (especially with selenium) are effective, potentially via anti-inflammatory mechanisms.
• Enteral immunonutrient mixtures are effective in surgical patients, but their use in critically ill patients is controversial due to potential increased mortality, possibly linked to high arginine content.

Conclusions:

• Specific nutrients can beneficially modulate inflammation and immune function in surgical and trauma patients.
• The use of broad immunonutrient mixtures in critically ill patients requires careful consideration due to controversial findings regarding mortality.
• Further research is needed to optimize nutrient interventions for different patient populations and clinical conditions.