The Clinical Value of Parenteral Immunonutrition in Surgical Patients

Early enteral supplementation with key pharmaconutrients improves Sequential Organ Failure Assessment score in critically ill patients with sepsis: Outcome of a randomized, controlled, double-blind trial*

“…Apart from its metabolic pathway effects, possible mechanisms behind these actions include the ability of glutamine to up-regulate heat shock protein 70 and peroxisome proliferator-activated receptor ␥ (26, 28 -30) and down-regulate activator protein 1 (30). Some or all of these effects combine to protect the gut and reduce the permeability defect associated with critical illness (31), which may help to explain the beneficial effects of glutamine on some measures of gut permeability, infection rates, immune function, and outcome reported in several clinical trials (32)(33)(34)(35)(36)(37). Glutamine itself is relatively insoluble in water, difficult to store in solution, and unstable during heat sterilization, which made it difficult to incorporate into commercially available enteral and parenteral feeding products before the quite recent introduction of stable, highly soluble glutamine dipeptides (38).…”

Quality of Care Indicators for the Surgical Treatment of Gastric Cancer: A Systematic Review

“…75 In three RCTs, immunonutrition was associated with less infectious complications and a shorter hospital stay. [76][77][78] Due to its high costs, shorter hospital stay did not lead to less overall costs. 77 In earlier days, nasogastric decompression has been used routinely to prevent anastomotic leakage, enhance bowel function, and shorten hospital stay.…”

“…[76][77][78] Due to its high costs, shorter hospital stay did not lead to less overall costs. 77 In earlier days, nasogastric decompression has been used routinely to prevent anastomotic leakage, enhance bowel function, and shorten hospital stay. However, none of the studies documented a benefit in postoperative morbidity or mortality of routine nasogastric or nasojejunal decompression.…”

Nutrients with immune-modulating effects: what role should they play in the intensive care unit?

“…Klek et al randomized 105 preoperative gastric cancer patients to receive postoperative total parenteral nutrition that was either standard, supplemented with glutamine, or supplemented with omega-3 PUFAs. The latter two groups had fewer infectious complications and a shorter LOS [9].…”