The notion that nutritional supplementation, or
immunonutrition, can alter the outcome from conditions characterized by
infection and inflammation, such as sepsis and ARDS, is controversial.
Galban and colleagues conducted a randomized, controlled clinical trial
in which they compared a nutritional formula supplemented with
arginine, messenger RNA, and omega-3 fatty acids from fish oil (Impact;
Novartis Nutrition; Bern, Switzerland) with a high-protein
enteral feed without these nutrients, administered to 176 septic
patients from six Spanish ICUs. The mortality rate was reduced
(19.1% vs 32.2%, p = 0.05), as were acquired bacteremias
(7.9% vs 21.8%, p = 0.01) and cases with multiple nosocomial
infections (5.6% vs 19.5%, p = 0.01) in the immunonutrition group.
Length of stay was not affected. Unexpectedly, most of the mortality
benefit was confined to the least sick patients, who had APACHE (acute
physiology and chronic health evaluation) II scores of 10 to 15, and
there was clearly no treatment benefit for the sickest patients, who
had APACHE II scores > 25.