Immunonutrition in the Critically Ill

Immunomodulating diets (IMDs) are complete balanced nutritional formulations that are supplemented with increased quantities of nutrients that have been demonstrated to improve immune cell function and modulate inflammation. Accumulating data suggests that the patients’ underlying disease and immune status should dictate the type of IMD prescribed. The use of IMD’s in patients with sepsis is complex as these patients typically have a proinflammatory phase followed by an immuno-paretic phase. However, an IMD containing omega-3 fatty acids should be considered in the early stage of sepsis. Unlike the bimodal response following sepsis, surgery and traumatic injuries typically result in immuno-paresis, which may sometimes be profound. Evidence based data strongly suggests that an IMD containing arginine, omega-3 fatty acids and oxidants should be considered in all patients undergoing major surgery, following trauma injuries and in malnourished hospitalized patients.