Immunonutrition Helps Critically Ill Patients

The use of immunonutrition tube-fed nutritional supplements that help maintain or boost the immune system appears to help improve the health of critically ill patients after a medical procedure or trauma.

``Any critically ill patients suitable for enteral [tube] feeding may potentially benefit from immune-enhancing enteral feeds,'' said Dr. Richard Beale, a consultant in the intensive care medicine unit at Guy's and St. Thomas' Hospital Trust in London. ``This is good news for everyone concerned with care of this important patient group, and the results have significant implications for hospital critical care departments.''

Beale led a group of researchers who reviewed data from 15 previously published studies to determine the overall effect of immunonutrition on the health of critically ill patients. This analysis comprised data from 1,482 patients who experienced a major planned surgery, trauma or sepsis (pathogens or their toxins in the blood or other tissues).

The researchers found that, on average, giving critically ill patients immunonutrition lowered the infection rate by about a third, reduced the time patients spent on a ventilator by about two-and-a-half days and reduced the overall length of hospital stays by almost three days. Immunonutrition had no effect on mortality, diarrhea, calorie intake or nitrogen intake.

Patients who had undergone surgery experienced the greatest benefit from immunonutrition, though the formulas were beneficial for the trauma and sepsis patients as well.

The study was published in the December issue of the journal Critical Care Medicine (www.sccm.org/jrnl/jrnlcmet.html).

Some physicians may be reluctant to use immunonutrition because of the uncertain benefit and extra cost, explained the researchers. But because the formulas appear to reduce costly hospital stays by three days, the results ``would suggest that immunonutrition is likely to be cost-effective in spite of the extra expense of the feed,'' the authors wrote in the study.

Immunonutrition formulas contain three groups of nutrients that are important for recovery: amino acids, fatty acids and nucleotides building blocks of DNA that play a role in cellular function and integrity. Two formulas, IMPACT (Novartis Nutrition, Bern, Switzerland) and Immun-Aid (McGaw, Irvine, Calif.), are currently on the market for use in critically ill patients.

``This is a whole new focus in critical care prevention of trouble before it arises rather than treating the problem once it's arrived,'' said Dr. Robert G. Martindale, associate professor of surgery and director of surgical nutrition at the Medical College of Georgia in Augusta.

Martindale, who was not involved in the study, said he uses immunonutrition in about 30 to 40 percent of the critically ill population he treats, and he typically keeps such patients on the formula for seven to 10 days after the trauma or procedure.

``In the past, we've always taken the idea that if a patient gets an infection, we'll just treat it with a bigger and better antimicrobial agent, whether it be fungal or bacterial,'' he said. ``Now we've got so many resistant bacteria and so many growing strains of resistant fungus that we have to say, 'Let's take a different approach now. Let's go back and enhance the patient's immune function to prevent this infection.'''

Martindale said he recently helped coordinate a study in which patients received immunonutrition for one week prior to a planned surgery. ``Those patients had excellent outcomes,'' he said.

In addition to helping prevent infections and other complications following surgery, giving patients immunonutrition before the procedure had a positive mental effect as well. ``Psychologically, the patients had a whole different perspective,'' he said. ``All of a sudden, they took control of a part of their disease.''

Critical Care Medicine (1999;27:2799-2805)

The Medical Tribune Web site is at http://www.medtrib.com

Ann's NOTE: What we eat matters and this study helps demonstrate that. The tide is turning. Eat organic whole foods and supplement. In my opinion it can only help cancer patients to do so.


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Found in an obituary on June 26, 2000 Dr. Elise Widdowson, age 93


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