ABSTRACT
Objetivos: revisar os conhecimentos atuais sobre o uso de imunonutrientes em pacientes críticos, especialmente naqueles com sepse.Fonte de dados: foi realizada uma revisão narrativa da literatura, utilizando as bases de dados Medline/Pubmed. Os artigos pesquisados compreendem publicações entre 2000 e 2011. Foram incluídos também artigos obtidos em referências bibliográficas dos artigos com maior relevância. Foram selecionados trabalhos referentes a indivíduos humanos adultos.Síntese dos dados: os estudos utilizaram diferentes fórmulas contendo imunonutrientes, nem sempre com os mesmos imunomoduladores. A quantidade administrada também variou de acordo com o tipo de fórmula, a tolerância do paciente e a via de administração. Efeitos favoráveis e desfavoráveis resultaram da administração de dietas enriquecidas com nutrientes imunomoduladores em pacientes com sepse.Conclusões: a literatura é bastante controversa em relação à recomendação do uso de imunonutrientes em pacientes críticos, sobretudo naqueles com sepse. Ainda não há resultados consistentes sobre a eficiência e a segurança da imunonutrição nesses pacientes. São necessários estudos com desenho metodológico e população mais homogêneos, utilizando imunonutrientes isolados e com quantidades definidas.
Aims: To review the current knowledge on the use of immunonutrients in critically ill patients, especially those with sepsis.Source of data: A narrative review of the literature was conducted, using the Medline/Pubmed data bases. The selected articles included publications between 2000 and 2011. Articles cited in reference lists of articles with the highest relevance were also included. Works on adult human individuals were selected.Summary of findings: Studies used different formulas containing immunonutrients, not always with the same immunomodulators. The given amount varied according to the type of formula, the patient?s tolerance and the route of administration. Favorable and unfavorable effects appeared as a result of administration of diets enriched with immunomodulator nutrients in patients with sepsis.Conclusions: Literature is controversial regarding the recommendation to use immunonutrients in critically ill patients, especially those with sepsis. There is currently no evidence to define the efficiency and safety of immunonutrition in these patients. For more consistent results, studies should be conducted with more homogeneous methodological design and population, using isolated immunonutrients in defined dosis.
Subject(s)
Humans , Adult , Adjuvants, Immunologic , Nutritional Support , Critical Care , Nutritional Physiological Phenomena/immunology , Nutrients , Enteral Nutrition , Sepsis , Dietary Supplements , Nutrition TherapyABSTRACT
Over last two decades the role of certain nutrients has been found to have pharmacologic effect on immune and inflammatory parameters. The modulation of the activities of the immune activation by nutrients or specific food items fed in amounts above these normally encountered in the diet are defined as Immunonutrients. Few examples are omega-3 polyunsaturated fatty acid, glutamine, Arginine, Nucleotides, Taurine, Probiotics and many more. Use of these nutrients to hospitalized patients decrease the length of stay in hospitals and also infection rate. Glutamine has an essential nutrients for immune cells and important modulator of gut barrier function and it is also a substrate for glutathione synthesis. Thus it plays a pivotal role as an antioxidant thus has more specific effect on the function of lymphocytes. Arginine is an essential amino acids during growth and may become essential in catabolic state. It is the precursor for nitric acid [NO] which is important for immune function, thus it stimulates T-cell proliferation and activation. Omega-3PUFA has immunonutrient function due to their anti-inflammatory properties. In burn patient's it improves survival and reduces infection complication by decreasing the level of PGE2 in them. Taurine has role in membrane stabilization, osmoregulation and calcium influx regulation. Ganglionides have potent effects on cellular immune reactions. Even oat fibres and guar gum and pectin has shown to stimulate gastrointestinal associated lymphoid tissue and to protect the GI mucosa against oxidative damage. Many nutritional formulas are being developed which contain L-plantarum fermented oat fibre which pave the way for Immuno nutrients research to expand into new and exiting area