ABSTRACT
Systemic inammatory response syndrome (SIRS) is the name given to the uncontrolled inammatory response to an insult (e.g., surgery, trauma, burns) and involving excessive production of inammatory cytokines, particularly tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, and IL-8 (Bone et al., 1997). Sepsis is the presence of SIRS in response to, or in combination with, an infection (Bone et al., 1997). The mortality risk of sepsis is about 20%, and it predisposes to organ failure, which carries an even greater mortality risk. Septic shock is the occurrence of multiple organ failures, metabolic acidosis, and hypotension, and it carries a mortality risk of 40%–80% (Bone et al., 1997). Together with SIRS, sepsis and septic shock
Introduction ............................................................................................................309 Concept of Immunonutrition .................................................................................. 310 Scientic Rationale for the Specic Nutrients Included in ImmuneModulating Articial Nutrition (aka Immunonutrition) ........................................ 311
Glutamine .......................................................................................................... 312 Arginine ............................................................................................................. 316 N-Acetyl Cysteine ............................................................................................. 317 Omega-3 Fatty Acids from Fish Oil .................................................................. 317
Omega-3 Fatty Acids in Parenteral Nutrition ............................................... 317 Omega-3 Fatty Acids in Enteral Nutrition.................................................... 319
Antioxidant Micronutrients and Trace Elements .............................................. 321 Mixtures of Immunonutrients Used Enterally................................................... 322
Conclusion ............................................................................................................. 324 References .............................................................................................................. 325
are termed “septic syndromes.” Septic syndromes are the leading cause of death in critically ill patients in Western countries (Angus et al., 2001). This chapter is based on, and updated from, an earlier publication on this topic (Calder, 2007).
