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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, mRNA, and ω‐3 fatty acids from fish oil (Impact), improves clinical outcomes, when compared with a common use, high protein enteral feed without these 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) presenting for enteral nutrition in an ICU. Interventions: Septic ICU patients with Acute Physiology and Chronic Health Evaluation (APACHE) II scores of ≥10 received either an enteral feed enriched with arginine, mRNA, and ω‐3 fatty acids from 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 mortality 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 treatment group (7 of 89 vs. 19 of 87; p = .01) as well as the number of patients 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 reduction in the mortality rate and infection rate in septic patients admitted to the ICU. These reductions were greater for patients with less severe illness.