European round table: the use of immunonutrients in the critically ill

In conclusion it was agreed that: • All patient groups should receive optimal nutritional support. Whilst it is clearly preferable for patients to receive their nutrition by the enteral route this is not always possible and supplementation with parenteral may be required. • Both enteral and parenteral nutrition can cause serious complications. Invasive techniques of delivery should be carefully monitored and only performed by those institutions with appropriate expertise. • Evidence-based clinical practice guidelines are useful and may contribute to an improvement in the nutritional care of critically ill-patients. • Arginine enriched enteral formulae should not be used in the critically ill. There is weak evidence to suggest benefit in other groups of surgical patients. • There is a reasonable level of evidence to support the use of glutamine enriched parenteral formulae. There is good evidence to confirm that it is not associated with harm and some evidence to suggest benefit. The evidence is less compelling for enteral glutamine. • There is increasing evidence to support the use of antioxidants such as selenium in the critically ill. • There is insufficient evidence to support the routine use of probiotics or n-3 chain fatty acids. • Clinicians wishing to use immunonutrients are strongly urged to participate in prospective clinical studies. • Future studies should be adequately powered to detect significant differences in primary end points. • Future studies investigating the effects of single immunonutrients are preferable to "cocktails" of drugs. In this way, adverse effects are more likely to be detected. • End points other than mortality and morbidity should be considered. • Morbidity relating to feeding methods employed should always be recorded together with adequacy of nutritional intakes. • All studies should be analysed on an "intention to treat" basis. © 2004 Elsevier Ltd. All rights reserved.