Immune function and organ failure. Immunomodulation with nutritional substrates - an update

Today, substrates with immunomodulatory effects are not only identified in all groups of macronutrients, but also in the domains of vitamines and trac eelements. Mainly they interfere with 3 areas of the immune response: 1. th e mucosal barrier function, 2. the cellular defense function, and 3. the lo cal or systemic inflammatory response. Enteral formulas enriched with immun e-enhancing diets are already in clinical use to encounter "immunoparalysis " of cellular defense during critical illness. Considering defined outcome variables,indeed, current clinical studies point out some improvements. Usi ng an evidence based approach, a grade A recommendation was proclaimed for its broad clinical use. For defined subgroups of patients, however, present ing with most severe appearances of SIRS and consecutive organ failure, the current concept of enteral immunonutrition remains to be a matter of debat e, and the evidence of clinical benefits persist to be questionable.