Comment on: 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

Objective: To assess the safety and efficacy of an early enteral pharmaconutrition supplement containing glutamine dipeptides, antioxidative vitamins and trace elements, and butyrate in critically ill, septic patients. Design: A prospective, randomized, controlled, double-blind clinical trial. Setting: Adult intensive care unit in a university hospital. Patients: Fifty-five critically ill, septic patients requiring enteral feeding. Interventions: Patients received either an enteral supplement (500 ml of Intestamin, Fresenius Kabi) containing conditionally essential nutrients or a control solution via the nasogastric route for up to 10 days. Inclusion occurred within 24 hours of intensive care unit admission. Additionally, patients received enteral feeding with an immunonutrition formula (experimental group) or standard formula (control group) initiated within 48 hours after enrollment. Measurements and main results: Organ dysfunction was assessed by daily total Sequential Organ Failure Assessment (SOFA) score over the 10-day study period in both patient groups. Patients receiving the experimental supplement showed a significantly faster decline in the regression slopes of delta daily total SOFA score over time compared with control. The difference between the regression coefficients of the 2 slopes was significant irrespective of the level of analysis: intent to treat –0.32 vs –0.14, P < .0001; per protocol– 0.34 vs –0.14, P < .0001; and completers (patients receiving ≥80% of the calculated caloric target over a period of 6 days)– 0.26 vs –0.16, P = .0005. Vitamin C, as a marker of supplement absorption, increased from 10.6 (1.9-159.4) μmol/L (normal range 20-50 μmol/L) on day 1 to 58.7 (5.4-189.9) μmol/L by day 3 (P = .002) in the intervention group but remained below the normal range in the control group 17.0 (2.8-78.5) on day 1 and 14.3 (2.4-179.6) on day 3. Serum levels of glycine, serine, arginine, ornithine, vitamin E, and β-carotene all increased significantly with treatment in the supplementation group. Conclusions: In medical patients with sepsis, early enteral pharmaconutrition with glutamine dipeptides, vitamin C and E, β-carotene, selenium, zinc, and butyrate in combination with an immunonutrition formula results in significantly faster recovery of organ function compared with control.