Impact of immunonutrient use on clinical out comes in critical patients: a systematic review of clinical trials
DOI:
https://doi.org/10.12957/demetra.2023.77540Keywords:
Imunomodulação. Estado crítico. Avaliação de Resultados em Cuidados de SaúdeAbstract
Objective: To describe the outcomes regarding the impact of immunonutrients on mortality rates, length of hospitalization, duration of Intensive Care Unit (ICU) stays, and the incidence of infections in adult and elderly critical patients. Method: An integrative literature review was conducted using the PubMed, LILACS, SciELO, Medline, and Google Scholar databases, using the descriptors: ("immunomodulation" OR "immunonutrients") AND ("fatty acids, Omega-3" OR "eicosapentaenoic Acid") AND ("glutamine") AND ("critical illness" OR "critical illnesses" OR "critically ill"), without language restrictions. The search encompassed studies that were published between 2012 and 2022. Results: Fifteen publications were identified in the conducted searches, of which eleven met all the established criteria at the outset of the study. Although some studies involving individuals supplemented with immunomodulatory formulas demonstrated improvements in ICU length of stay, a reduced incidence of sepsis and septic shock, and a lower infection rate, most of the evaluated studies did not reveal significant differences between the supplemented groups and the control groups or did not yield statistically significant outcomes. Conclusion: The management of care for critical patients necessitates a cautious and individualized approach, underpinned by scientific evidence. The analysis of clinical studies forming part of this research revealed an absence of statistically significant results pertaining to the practice of immunomodulation utilization in critical patients with respect to effects on mortality, ICU length of stay, total hospitalization, and the incidence of infections. Further studies are required to validate the genuine benefits of adopting this approach.
References
Ministério da Saúde. Portaria nº 2.338, de 3 de outubro de 2011. Estabelece diretrizes e cria mecanismos para a implantação do componente Sala de Estabilização (SE) da Rede de Atenção às Urgências; 2011. [Acesso em 11 out. 2022]. Disponível em: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt2338_03_10_2011.html
Jereb S, Asus N, Blumtritt M, Kreff Y, Lipovestky F, Magnífico L et al . Inmunonutrición en el paciente crítico. Diaeta .2016;34( 155 ): 48-55. [Acesso em 11 out. 2022]. Disponível em: http://www.scielo.org.ar/scielo.php?script=sci_abstract&pid=S1852-73372016000200007&lng=es&nrm=iso&tlng=es
McCarthy MS, Martindale RG. Immunonutrition in critical illness: what is the role? Nutr in Clin Pract [Internet]. 2018;33(3):348-58.
https://doi.org/10.1002/ncp.10102.
Grimble RF. Grimble RF. Nutritional modulation of immune function. Proc Nutr Soc. 2001;60(3):389–97. https://doi.org/10.1079/pns2001102
Lobo GM, Santos MP dos. Benefícios do uso da glutamina em pacientes críticos. Revista Brasileira De Nutrição Clínica. 2012;27(2):112-8.
Mottaghi A, Yeganeh MZ, Golzarand M, Jambarsang S, Mirmiran P. Efficacy of glutamine-enriched enteral feeding formulae in critically ill patients: a systematic review and meta-analysis of randomized controlled trials Asia Pac J Clin Nutr. 2016;25(3):504-12. https://doi.org/10.6133/apjcn.092015.24
Sun Y, Zhu S, Li S, Liu H. Glutamine on critical-ill patients: a systematic review and meta-analysis. Ann Palliat Med. 2021;10(2):1503–20. https://doi.org/10.21037/apm-20-702
López JMM, Izquierdo FJE, León MP, López RM, González MH, Señaris JAA. Glutamina: su papel enel paciente crítico. Actual. Nutr. 2015;72-79. [Acesso em 11 out. 2022]. Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/lil-771520?lang=es
(Kristine) Koekkoek W, Panteleon V, van Zanten AR. Current evidence on ω-3 fatty acids in enteral nutrition in the critically ill: A systematic review and meta-analysis. Nutrition. March 2019;59:56-68.
https://doi.org/10.1016/j.nut.2018.07.013
Thienprasert A, Samuhaseneetoo S, Popplestone K, West AL, Miles EA, Calder PC. Fish oil n-3 polyunsaturated fatty acids selectively affect plasma cytokines and decrease illness in Thai schoolchildren: a randomized, double-blind, placebo-controlled intervention trial. The Journal of Pediatrics. 2009;154(3):391-5. https://doi.org/10.1016/j.jpeds.2008.09.014
Malan L, Baumgartner J, Calder PC, Zimmermann MB, Smuts CM. N-3 long-chain PUFAs reduce respiratory morbidity caused by iron supplementation in iron-deficient South African schoolchildren: A randomized, double-blind, placebo-controlled intervention. The American Journal of Clinical Nutrition. 2014;101(3)-pp. 668-679. https://doi.org/10.3945/ajcn.113.081208
Calder PC. Functional roles of fatty acids and their effects on human health. JPEN Journal of Parenteral and Enteral Nutrition. 2015;39 (1Suppl):18S32S. https://doi.org/10.1177/0148607115595980
Manzanares W, Dhaliwal R, Jurewitsch B, Stapleton RD, Jeejeebhoy KN, Heyland DK. Parenteral fish oil lipid emulsions in the critically ill: a systematic review and meta‐analysis. J Parenter Enteral Nutr. 2013;38(1):20-8. https://doi.org/10.1177/0148607113486006
Langlois PL, D’Aragon F, Hardy G, Manzanares W. Omega-3 polyunsaturated fatty acids in critically ill patients with acute respiratory distress syndrome: A systematic review and meta-analysis. Nutrition. 2019;61:84-92. https://doi.org/10.1016/j.nut.2018.10.026
Palmer AJ, Ho CKM, Ajibola O, Avenell A. The role of ω-3 fatty acid supplemented parenteral nutrition in critical illness in adults: a systematic review and meta-analysis. Critical Care Medicine. 2013;41(1):307-16.
https://doi.org/10.1097/ccm.0b013e3182657578
Sousa LMMS, Marques-Vieira CMA, Severino SS, Antunes AV. A Metodologia de Revisão Integrativa da Literatura em Enfermagem. Revista Investigação em Enfermagem. 2017 Nov 1. [Acesso em 11 out. 2022]. Disponível em: https://www.researchgate.net/publication/321319742_Metodologia_de_Revisao_Integrativa_da_Literatura_em_Enfermage
Mendes KDS, Silveira RC de CP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto & Contexto - Enfermagem. 2008 Dec;17(4):758-64. https://doi.org/10.1590/S0104-07072008000400018
Pompeo DA, Rossi LA, Galvão CM. Revisão integrativa: etapa inicial do processo de validação de diagnóstico de enfermagem. Acta Paulista de Enfermagem. 2009;22(4):434-8. https://doi.org/10.1590/S0103-21002009000400014
Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement. PLoS Medicine. 2009 Jul 21;6(7). https://doi.org/10.1371/journal.pmed.1000097
M Elamin E, Miller AC, Ziad S. Immune Enteral Nutrition Can Improve Outcomes in Medical-Surgical Patients with ARDS: A Prospective Randomized Controlled Trial. Journal of Nutritional Disorders&Therapy. 2012;02(02). ).https://doi.org/10.4172/2161-0509.1000109
van Zanten ARH, Sztark F, Kaisers UX, Zielmann S, Felbinger TW, Sablotzki AR, et al. High-Protein Enteral Nutrition Enriched With Immune-Modulating Nutrientsvs Standard High-Protein Enteral Nutritionand Nosocomial Infections in the ICU. JAMA. 2014 Aug 6;312(5):514.
https://doi.org/10.1001/jama.2014.7698
Barros KV, Cassulino AP, Schalch L, Della Valle Munhoz E, Manetta JA, Noakes PS, et al. Supplemental Intravenous n-3 fatty acid sand n-3 fatty acid status and out come incritically ill elderly patients in the ICU receiving enteral nutrition. Clinical Nutrition. 2013 Aug;32(4):599-605.
https://doi.org/10.1016/j.clnu.2012.10.016
Hosny M, Nahas R, Ali S, Elshafei SA, Khaled H. Impact of oral omega-3 fatty acid supplementation in early sepsis on clinical out come and immunomodulation. The Egyptian Journal of Critical Care Medicine. 2013 Sep;1(3):119-26. https://doi.org/10.1016/j.ejccm.2013.11.002
Hall TC, Bilku DK, Al-Leswas D, Neal CP, Horst C, Cooke J, et al. A Randomized Controlled Trial Investigating the Effects of Parenteral Fish Oil on Survival Outcomes in Critically Ill Patients With Sepsis. Journal of Parenteral and Enteral Nutrition. 2014 Jan 9;39(3):301-12.
https://doi.org/10.1177/0148607113518945
Parish M, Valiyi F, Hamishehkar H, Sanaie S, Asghari Jafarabadi M, Golzari SE, et al. The effect of omega-3 fatty acids on ards: a randomized double-blind study. Advanced Pharmaceutical Bulletin. 2014;4(2):555-61. https://doi.org/10.5681%2Fapb.2014.082
Tihista S, Echavarría E. Effect of omega 3 polyunsaturated fatty acids derived from fish oil in major burn patients: A prospective randomized controlled pilot trial. Clinical Nutrition. 2018;37(1):107-12. https://doi.org/10.1016/j.clnu.2017.01.002
Martínez-Lozano Aranaga F, Gómez Ramos MJ, Sánchez Álvarez MDC. Effectiveness and safety of two lipid emulsions for parenteral nutrition in postsurgical critically ill patients: Clinoleic® versus SMOFlipid®. Nutr Hosp; 2020. https://doi.org/10.20960/nh.03077
Singer P, Bendavid I, Mesilati-Stahy R, Green P, Rigler M, Lev S, et al. Enteral and supplemental parenteral nutrition enriched with omega-3 polyunsaturated fatty acids in intensive care patients – A randomized, controlled, double-blind clinical trial. Clinical Nutrition. 2021;40(5):2544–54. https://doi.org/10.1016/j.clnu.2021.03.034
Heyland D, Muscedere J, Wischmeyer PE, Cook D, Jones G, Albert M, et al. A randomized trial of glutamine and antioxidants in critically ill patients. N Engl J Med. 2013;368(16):1489-97. https://doi.org/10.1056/nejmoa1212722
Ziegler TR, May AK, Hebbar G, Easley KA, Griffith DP, Dave N, et al. Efficacy and safety of glutamine-supplemented parenteral nutrition in surgical icu patients: an american multicenter randomized controlled trial. Annals of Surgery. 2016;263(4):646–55: https://doi.org/10.1097%2FSLA.0000000000001487
Farias L, Sousa E, Vasconcelos V. Uso de dietas imunomoduladoras em pacientes de unidade de terapia intensiva de hospitais de Teresina – PI. Rev Bras Nutr Clin 2014;29(1):8-13. [Acesso em 11 out. 2022]. Disponível em:
http://www.braspen.com.br/home/wp-content/uploads/2016/12/02-uso-de-dietas.pdf
Van Zanten ARH, Dhaliwal R, Garrel D, Heyland DK. Enteral glutamine supplementation in critically ill patients: a systematic review and meta-analysis. Crit Care. 2015;19(1). https://doi.org/10.1186/s13054-015-1002-x
McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. 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.). J Parenter Enteral Nutr. 2016;40(2):159-211. https://doi.org/10.1177/0148607115621863
Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clinical Nutrition. 2019;38(1):48-79. https://doi.org/10.1016/j.clnu.2018.08.037
Compher C, Bingham AL, McCall M, Patel J, Rice TW, Braunschweig C, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. J Parenter Enteral Nutr. 2021;46(1). https://doi.org/10.1002/jpen.2267
Castro M, Ribeiro P, Souza I, Cunha H, Silva M, Rocha E, et al. Diretriz Brasileira de Terapia Nutricional no Paciente Grave. BRASPEN Journal. 2018;33(Supl 1):2-36. [Acesso em 11 out. 2022]. Disponível em:
https://expertisecia.com/wp-content/uploads/2021/04/BRASPEN-DITEN-2018.pdf
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