© 2000 Evidence-Based Nursing
Immune enhancing enteral nutrition reduced mortality and acquired infections in intensive care unit patients with sepsis
Galbán C, Montejo JC, Mesejo A, et al.An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients.Crit Care Med 2000 Mar;28:643–8[Medline]
QUESTION: Among patients in the intensive care unit (ICU) with sepsis, is immune enhancing enteral feeding more effective than high protein enteral feeding for reducing mortality and subsequent episodes of bacteraemia?
Randomised (unclear allocation concealment), unblinded controlled trial.
6 hospitals in Spain.
181 patients >14 years of age who were admitted to the ICU, had sepsis (positively cultured or clinically diagnosed infection), and had an Acute Physiology and Chronic Health Evaluation (APACHE) II score 
10. Exclusion criteria were pregnancy, previous radiotherapy, previous treatment with immune enhancing enteral or parenteral nutrition, treatment with immunosuppressive drugs, AIDS, neoplasia, or metastases. Follow up was 97% (mean age 56 y, 73% men).
Patients received enteral feeds by nasoenteric, nasogastric, gastrostomy, or jejunostomy tube. Feeds were started within 36 hours of the diagnosis of sepsis, and total intake of caloric needs was to be reached by the fourth day. 94 patients were allocated to an immune enhancing formula (Impact), which was enriched with arginine, mRNA, and 
-3 fatty acids from fish oil. 87 patients were allocated to a high protein, control formula, Precitene Hiperproteico (Nutrodrip Protein).
Associate Professor, Faculty of Nursing Middle Tennessee State University Murfreesboro, Tennessee, USA
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