Evidence-based immune-modulating nutritional therapy in critically ill and injured patients

Background: Immunonutrition, both immune-enhancing (IE) and immune-modulating (IM), has become an important therapeutic option in the care of critically ill and injured patients. Methods: Review of current literature and evidence on the use of immunonutrition, in particular use of immune enhancing and immune modulating nutrition support in critically ill and injured patients. Results: We have gained much knowledge on the changes and on the mechanism of action of key nutrients and their substrates during critical illness and severe injuries, especially in acute respiratory distress syndrome (ARDS), sepsis, and septic shock; accordingly, the use of such nutrients and substrates has increased dramatically and has become Level I evidence (per the U.S. Preventive Services Task Force). Conclusions: There has been a significant paradigm shift with regard to selecting the appropriate nutritional strategy for critically ill and injured patients. Doing so for a particular patient and particular disease is no longer regarded as a supportive measure. Rather, it is regarded as direct nutritional therapy, based on molecular changes and on the biology of key nutrients induced by the disease process.