Immunologically enhanced enteral nutrition: current status.

With increasing interest in enteral feeding and the role of the gut in the development of infection and multiple organ failure in critically ill patients, the use of enteral feedings enriched with immune-enhancing ingredients is attracting considerable interest. This approach to modulating the immune and inflammatory responses has become known as immunonutrition, and many products are now available for clinical use. Several have been subjected to clinical study in various patient groups, with encouraging results in terms of reducing infection rates and length of hospital stay. They appear to benefit both critically ill patients and patients undergoing major surgery, particularly when feeding is started preoperatively. Two systematic reviews have been published, both with positive results. Nevertheless, as new products become available they should be subjected to controlled clinical trials, especially because several of the mechanisms involved are not yet fully understood.