Editor—The review by Calder highlights data from meta-analysis that propose a benefit from giving immunonutrition in critically ill patients,1 but the current literature does not support this.
Recent publications suggest an increase in mortality in patients with sepsis who are given immunonutrition.2,3 Interim analysis of a large, ongoing, multicentre Italian trial of immunonutrition showed an increased mortality in severe sepsis and septic shock.3 This was even more alarming given that the control group was fed parenterally (associated with an increase in mortality in the critically ill) and had more unfavourable baseline characteristics (age greater than 60 and combined cardiopulmonary failure). These results led to an end to recruitment of patients with severe sepsis and a recommendation that the immunonutrient arginine should not be used in severe sepsis.
Probiotics (live microbial food ingredients of benefit to health) are also immunonutrients (as defined by Calder) and yet little recognition is given to their immune enhancing properties in the critically ill. Research in intensive care in this discipline is still in its infancy, but preliminary studies have shown a mortality benefit in diverse groups of critically ill patients.4,5
The benefits of immunonutrition in critically ill patients are yet to be realised. Different patients might require different immunonutrients during critical illness, and these requirements might change at different stages of disease. Probiotics should not become the forgotten relative of the more commercial immunonutrient cocktails.
Competing interests: None declared.
References
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