Sepsis is a common disease seen in critically ill patients. Many patients with sepsis are unable to provide nutrition for themselves, and therefore initiating artificial nutrition has become part of routine care for these patients. However, studies investigating the optimal route, composition, volume, and duration of nutrition in critically ill patients with sepsis are lacking. The best recommendations have to be extrapolated from studies in heterogeneous populations of critically ill patients or in those with syndromes such as acute lung injury or acute respiratory distress syndrome (ARDS) where sepsis is a common predisposing etiology. In this review, we summarize pertinent studies that inform clinical practice on providing artificial nutrition to critically ill patients with severe sepsis and make recommendations as to how these studies influence clinical care of these patients.
AngusDCvan der PollT. Severe sepsis and septic shock. N Engl J Med. 2013;369(21):2063.
2.
DellingerRPLevyMMRhodesA. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165-228.
3.
Pontes-ArrudaAMartinsLFde LimaSM. Enteral nutrition with eicosapentaenoic acid, γ-linolenic acid and antioxidants in the early treatment of sepsis: results from a multicenter, prospective, randomized, double-blinded, controlled study: the INTERSEPT study. Crit Care. 2011;15(3):R144.
4.
RiceTWWheelerAP. Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA. 2012;307(8):795-803.
5.
RiceTWMoganSHaysMA. Randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure. Crit Care Med. 2011;39(5):967-974.
6.
NeedhamDMDinglasVDBienvenuOJ. One year outcomes in patients with acute lung injury randomised to initial trophic or full enteral feeding: prospective follow-up of EDEN randomised trial. BMJ. 2013;346:f1532.
7.
DoigGSSimpsonFSweetmanEA. Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a randomized controlled trial. JAMA. 2013;309(20):2130-2138.
8.
CasaerMPMesottenDHermansG. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365(6):506-517.
9.
ElkeGWangMWeilerNDayAGHeylandDK. Close to recommended caloric and protein intake by enteral nutrition is associated with better clinical outcome of critically ill septic patients: secondary analysis of a large international nutrition database. Crit Care. 2014;18(2):R29.
10.
MooreEEJonesTN. Benefits of immediate jejunostomy feeding after major abdominal trauma—a prospective, randomized study. J Trauma. 1986;26(10):874-881.
11.
ChiarelliAEnziGCasadeiA. Very early nutrition supplementation in burned patients. Am J Clin Nutr. 1990;51(6):1035-1039.
12.
McClaveSAMartindaleRGVanekVW. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2009;33(3):277-316.
13.
SingerPBergerMMVan den BergheG. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr. 2009;28(4):387-400.
14.
HernandezGVelascoNWainsteinC. Gut mucosal atrophy after a short enteral fasting period in critically ill patients. J Crit Care. 1999;14(2):73-77.
15.
HadfieldRJSinclairDGHouldsworthPEEvansTW. Effects of enteral and parenteral nutrition on gut mucosal permeability in the critically ill. Am J Respir Crit Care Med. 1995;152(5, pt 1):1545-1548.
16.
McClureRJNewellSJ. Randomised controlled study of clinical outcome following trophic feeding. Arch Dis Child Fetal Neonatal Ed. 2000;82(1):F29-F33.
17.
ZalogaGPBlackKWPrielippR. Effect of rate of enteral nutrient supply on gut mass. JPEN J Parenter Enteral Nutr. 1992;16(1):39-42.
18.
DoigGSHeighesPTSimpsonF. Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomised controlled trials. Intensive Care Med. 2009;35(12):2018-2027.
19.
MarikPEZalogaGP. Early enteral nutrition in acutely ill patients: a systematic review. Crit Care Med. 2002;30(3):725.
20.
HarveySEParrottFHarrisonDA. Trial of the route of early nutritional support in critically ill adults. N Engl J Med. 2014;371(18):1673-1684.
21.
NeedhamDMDinglasVDBienvenuOJ. One year outcomes in patients with acute lung injury randomised to initial trophic or full enteral feeding: prospective follow-up of EDEN randomised trial. BMJ. 2013;346:f1532.
22.
BraunschweigCASheeanPMPetersonSJ. Intensive nutrition in acute lung injury: a clinical trial (INTACT). JPEN J Parenter Enteral Nutr. 2015;39(1):13-20.
23.
CalderPC. N-3 fatty acids, inflammation, and immunity—relevance to postsurgical and critically ill patients. Lipids. 2004;39(12):1147-1161.
24.
PrescottSMStensonWF. Fish oil fix. Nat Med. 2005;11(6):596-598.
25.
LelcukSHuvalWVValeriCRSheproDHechtmanHB. Inhibition of ischemia-induced thromboxane synthesis in man. J Trauma. 1984;24(5):393-396.
26.
Pontes-ArrudaADemicheleSSethASingerP. The use of an inflammation-modulating diet in patients with acute lung injury or acute respiratory distress syndrome: a meta-analysis of outcome data. JPEN J Parenter Enteral Nutr. 2008;32(6):596-605.
27.
GalbanCMontejoJCMesejoA. An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients. Crit Care Med. 2000;28(3):643-648.
28.
BealeRJSherryTLeiK. Early enteral supplementation with key pharmaconutrients improves Sequential Organ Failure Assessment score in critically ill patients with sepsis: outcome of a randomized, controlled, double-blind trial. Crit Care Med. 2008;36(1):131-144.
29.
GadekJEDeMicheleSJKarlstadMD. Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ARDS Study Group. Crit Care Med. 1999;27(8):1409-1420.
30.
SingerPTheillaMFisherHGibsteinLGrozovskiECohenJ. Benefit of an enteral diet enriched with eicosapentaenoic acid and gamma-linolenic acid in ventilated patients with acute lung injury. Crit Care Med. 2006;34(4):1033-1038.
31.
RiceTWWheelerAPThompsonBT. Enteral omega-3 fatty acid, gamma-linolenic acid, and antioxidant supplementation in acute lung injury. JAMA. 2011;306(14):1574-1581.
32.
Van ZantenARSztarkFKaisersUX. High-protein enteral nutrition enriched with immune-modulating nutrients vs standard high-protein enteral nutrition and nosocomial infections in the ICU: a randomized clinical trial. JAMA. 2014;312(5):514-524.
33.
HallTCBilkuDKAl-LeswasD. A randomized controlled trial investigating the effects of parenteral fish oil on survival outcomes in critically ill patients with sepsis: a pilot study. JPEN J Parenter Enteral Nutr. 2015;39(3):301-312.
34.
Grau-CarmonaTBonet-SarisAGarcia-de-LorenzoA. Influence of n-3 polyunsaturated fatty acids enriched lipid emulsions on nosocomial infections and clinical outcomes in critically ill patients: ICU Lipids Study. Crit Care Med. 2015;43:31-39.
35.
WohlmuthCDunserMWWorzingerB. Early fish oil supplementation and organ failure in patients with septic shock from abdominal infections: a propensity-matched cohort study. JPEN J Parenter Enteral Nutr. 2010;34(4):431-437.
36.
PalmerAJHoCKAjibolaOAvenellA. The role of omega-3 fatty acid supplemented parenteral nutrition in critical illness in adults: a systematic review and meta-analysis. Crit Care Med. 2013;41(1):307-316.
37.
PradelliLMayerKMuscaritoliMHellerAR. N-3 fatty acid-enriched parenteral nutrition regimens in elective surgical and ICU patients: a meta-analysis. Crit Care. 2012;16(5):R184.
38.
ChenWJiangHZhouZY. Is omega-3 fatty acids enriched nutrition support safe for critical ill patients? A systematic review and meta-analysis. Nutrients. 2014;6(6):2148-2164.
39.
KaoCCBandiVGuntupalliKKWuMCastilloLJahoorF. Arginine, citrulline and nitric oxide metabolism in sepsis. Clin Sci (Lond). 2009;117(1):23-30.
40.
GoughMSMorganMAMackCM. The ratio of arginine to dimethylarginines is reduced and predicts outcomes in patients with severe sepsis. Crit Care Med. 2011;39(6):1351-1358.
41.
HeylandDKDhaliwalRDroverJWGramlichLDodekP; Canadian Critical Care Clinical Practice Guidelines Committee. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr. 2003;27(5):355-373.
42.
NovakFHeylandDKAvenellADroverJWSuX. Glutamine supplementation in serious illness: a systematic review of the evidence. Crit Care Med. 2002;30:2022-2029.
43.
AndrewsPJAvenellANobleDW; Scottish Intensive care Glutamine or seleNium Evaluative Trial Trials Group. Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients. BMJ. 2011;342:d1542.
44.
WernermanJKirketeigTAnderssonB; Scandinavian Critical Care Trials Group. Scandinavian glutamine trial: a pragmatic multi-centre randomised clinical trial of intensive care unit patients. Acta Anaesthesiol Scand. 2011;55(7):812-818.
45.
HeylandDKMuscedereJWischmeyerP. A randomized trial of glutamine and antioxidants in critically ill patients (REDOXS). N Engl J Med. 2013;368:1489-1497.
46.
WischmeyerPEDhaliwalRMcCallMZieglerTRHeylandDK. Parenteral glutamine supplementation in critical illness: a systematic review. Crit Care. 2014;18(2):R76.
47.
LuikingYCPoezeMRamsayGDeutzNE. Reduced citrulline production in sepsis is related to diminished de novo arginine and nitric oxide production. Am J Clin Nutr. 2009;89(1):142-152.
48.
LiukingYCPoezeMDeutzNE. Arginine infusion in patients with septic shock increases nitric oxide production without haemodynamic instability. Clin Sci (Lond). 2015;128(1):57-67.
49.
VisserMVermeulenMARichirMC. Imbalance of arginine and asymmetric dimethylarginine is associated with markers of circulatory failure, organ failure and mortality in shock patients. Br J Nutr. 2012;107(10):1458-1465.
50.
SchetzMCasaerMPVan den BergheG. Does artificial nutrition improve outcome of critical illness?Crit Care. 2013;17(1):302-307.
51.
CasaerMPWilmerAHermansG. Role of disease and macronutrient dose in the randomized controlled EPaNIC trial: a post hoc analysis. Am J Respir Crit Care Med. 2013;187(3):247-255.
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