NUTRITIONAL SUPPORT AND INFECTION - DOES THE ROUTE MATTER

Questions regarding the effects of the route of nutrition began to sur face shortly after the introduction of total parenteral nutrition (TPN ). Although TPN has become a life-saving therapy for patients who cann ot tolerate enteral nutrition, it is not the panacea it was hoped to b e. It appears that the enteral route of nutrition decreases rates of i nfectious complications compared with parenteral feeding. Reasons for this phenomenon are not clear, but it seems that enteral nutrition sup ports the gut barrier and gut-associated lymphoid tissue, which may ha ve effects on infections at distant sites such as the lung. These effe cts do not appear to be due solely to prevention of malnutrition, as t he infectious complications develop early after injury or illness. How ever, the lack of understanding of the mechanisms does not negate the fact that in many clinical studies the enteral route of nutrition is s uperior to the parenteral route in terms of reducing infectious compli cations in critically ill or injured patients.