An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients

Objective: To determine whether early enteral feeding in a septic intensive care unit (ICU) population, using a formula supplemented with arginine, mR NA, and omega-3 fatty acids from fish oil (Impact), improves clinical outco mes, when compared with a common use, high protein enteral feed without the se nutrients. Design: A prospective, randomized, multicentered trial. Setting: ICUs of six hospitals in Spain. Patients: One hundred eighty-one septic patients (122 males, 59 females) pr esenting for enteral nutrition in an ICU, Interventions: Septic ICU patients with Acute Physiology and Chronic Health Evaluation (APACHE) II scores of greater than or equal to 10 received eith er an enteral feed enriched with arginine, mRNA, and omega-3 fatty acids fr om fish oil (Impact), or a common use, high protein control feed (Precitene Hiperproteico). Measurements and Main Results: One hundred seventy-six (89 Impact patients, 87 control subjects) were eligible for intention-to-treat analysis. The mo rtality rate was reduced for the treatment group compared with the control group (17 of 89 vs. 28 of 87; p < ,05), Bacteremias were reduced in the tre atment group (7 of 89 vs. 19 of 87; p = .01) as well as the number of patie nts with more than one nosocomial infection (5 of 89 vs. 17 of 87; p = .01) , The benefit in mortality rate for the treatment group was more pronounced for patients with APACHE II scores between 10 and 15 (1 of 26 vs, 8 of 29; p = .02), Conclusions: Immune-enhancing enteral nutrition resulted in a significant r eduction in the mortality rate and infection rate in septic patients admitt ed to the ICU, These reductions were greater for patients with less severe illness.