The effect of
nutritional support in
critically ill patients with
sepsis has received much attention in recent years. However, many of the studies have produced conflicting results. As for all
critically ill patients,
nutritional support, preferably via the enteral route, should be commenced once initial
resuscitation and adequate perfusion pressure is achieved. Where
enteral feeding is impossible or not tolerated,
parenteral nutrition (either as total or complimentary
therapy) may safely be administered. Most positive studies relating to
nutritional support and
sepsis have been in the setting of
sepsis prevention. Thus, the administration of standard nutrition formulas to
critically ill patients within 24 h of injury or intensive care unit admission may decrease the incidence of
pneumonia. Both
arginine-supplemented enteral diets, given in the
perioperative period, and
glutamine-supplemented
parenteral nutrition have been shown to decrease
infections in surgical patients. Parenteral
fish oil lipid emulsions as well as probiotics given in the
perioperative period may also reduce
infections in patients undergoing major abdominal operations, such as
liver transplantation. There is little support at the present time for the positive effect of specific pharmaconutrients, in particular
fish oil, probiotics, or
antioxidants, in the setting of established
sepsis. More studies are clearly required on larger numbers of more homogeneous groups of patients.