Nutritional metabolic management, together with other treatment and support measures used, is one of the mainstays of the treatment of septic patients.
Nutritional support should be started early, after initial life support measures, to avoid the consequences of
malnutrition, to provide adequate nutritional intake and to prevent the development of secondary complications such as
superinfection or multiorgan failure. As in other
critically-ill patients, when the enteral route cannot be used to ensure calorie-
protein requirements, the association of
parenteral nutrition has been shown to be safe in this subgroup of patients. Studies evaluating the effect of specific pharmaconutrients in septic patients are scarce and are insufficient to allow recommendations to be made. To date, enteral diets with a mixture of substrates with distinct pharmaconutrient properties do not seem to be superior to standard diets in altering the course of
sepsis, although equally there is no evidence that these diets are harmful. There is insufficient evidence to recommend the use of
glutamine in septic patients receiving
parenteral nutrition. However, given the good results and absence of
glutamine-related adverse effects in the various studies performed in the general population of
critically-ill patients, these patients could benefit from the use of this substance. Routine use of
omega-3 fatty acids cannot be recommended until further evidence has been gathered, although the use of
lipid emulsions with a high
omega-6 fatty acid content should be avoided. Septic patients should receive an adequate supply of essential
trace elements and
vitamins. Further studies are required before the use of high-dose
selenium can be recommended.