Effect of enteral immunomodulatory nutrition formula on mortality and critical care parameters in critically ill patients: A systematic review with meta-analysis

Mahsa Malekahmadi; Naseh Pahlavani; Safieh Firouzi; Zachary S Clayton; Sheikh Mohammed Shariful Islam; Sanaz Rezaei Zonooz; Omid Moradi Moghaddam; Sepideh Soltani

doi:10.1111/nicc.12687

Effect of enteral immunomodulatory nutrition formula on mortality and critical care parameters in critically ill patients: A systematic review with meta-analysis

Nurs Crit Care. 2022 Nov;27(6):838-848. doi: 10.1111/nicc.12687. Epub 2021 Jul 29.

Authors

Mahsa Malekahmadi^{1

2}, Naseh Pahlavani^{3

4

5}, Safieh Firouzi⁶, Zachary S Clayton⁷, Sheikh Mohammed Shariful Islam⁸, Sanaz Rezaei Zonooz⁹, Omid Moradi Moghaddam⁹, Sepideh Soltani¹⁰

Affiliations

¹ Department of Clinical Nutrition, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
² Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
³ Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.
⁴ Department of Nutrition and Biochemistry, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran.
⁵ Department of Clinical Biochemistry and Nutrition, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
⁶ Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
⁷ Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA.
⁸ Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia.
⁹ Trauma and Injury Research Center, Critical Care Department, Rasoul-e-Akram Complex Hospital, Iran University of Medical Sciences, Tehran, Iran.
¹⁰ Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

PMID: 34323346
DOI: 10.1111/nicc.12687

Abstract

Background: Enteral immunomodulatory nutrition is recommended as an adjuvant therapy for patients in intensive care units (ICU), but its effectiveness is incompletely understood.

Aim: The aim of this review was to examine the effect of a commonly used immunomodulatory formula-omega-3 fatty acids, γ-linolenic acid, and antioxidants-on clinical outcomes and mortality risk in critically ill patients.

Design: Systematic review and meta-analysis of randomized controlled trials (RCTs).

Method: PubMed, Scopus, and Institute for Scientific Information (ISI) Web of Knowledge databases were searched until 18 February 2021. RCTs that used the immunomodulatory formula in the ICU were included.

Results: Ten RCTs (1166 participants) were included in the meta-analysis. The immunomodulatory formula reduced the duration of ICU stay weighted mean difference [(WMD): -2.97 days; 95%CI: -5.59, -0.35)], mechanical ventilation (WMD = -2.20 days, 95%CI: -4.29, -0.10), sequential organ failure assessment and multiple organ dysfunction scores (Hedge's g: -0.42 U/L; 95% CI: -0.74, -0.11), decreased 8-day overall mortality risk (RR = 0.74, 95% CI: 0.58, 0.91), and extended the ICU-free days (WMD: 4.06 days, 95% CI: 0.02, 8.09). The improvement in respiratory function and reduction in mortality risk was more in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Furthermore, the reduction in mechanical ventilation and mortality risk was more evident in older (>60 years) vs young adults.

Conclusion and relevance to clinical practice: Taken together, the immunomodulatory formula may enhance clinical practice for critical care nurses, such that the prevalence and/or susceptibility to secondary conditions commonly encountered in the ICU (ie, ALI and ARDS) could be attenuated, ultimately allowing critical care nurses to focus their care on the primary reason for which a patient is in the ICU. The study protocol was registered in PROSPERO.

Keywords: antioxidants; critical care; enteral immunomodulatory formula; intensive care unit; omega-3 fatty acid; γ-linolenic acid.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Aged
Critical Care
Critical Illness* / therapy
Enteral Nutrition / methods
Humans
Intensive Care Units
Length of Stay
Respiration, Artificial
Respiratory Distress Syndrome* / therapy