Nutritional Support in Severe Sepsis

Nutritional support in severe sepsis remains a controversial issue. Although it has not been proven yet that nutritional support improves clinical outcome, it is considered a necessary strategy in the global treatment of sepsis. Recent developments in the knowledge of new substrates, such as olive oil–based emulsions or gamma-linolenic acid, open new perspectives as substrates that may modulate the inflammatory response in severe sepsis when adult respiratory syndrome or gastrointestinal failure may develop. However, the different effects that lipids have in immunomodulation, such as actions on cellular membranes, receptors, and intracellular signaling, make it difficult to point to fats as merely energy substrates. Regarding protein support, branched-chain amino acids, arginine, and glutamine seem to offer the most convenient alternative to standard formulations. Micronutrients play an important role, especially vitamins and some trace elements that perform an important function as antioxidant scavengers. Although vitamin needs have not been established for septic patients, the varied published recommendations seem to be far below the needs of these critically ill patients. Enteral nutrition remains to be preferable to intravenous, but the changes found in intestinal absorption and transport in severe sepsis may limit the use of enteral feeding. In some cases, it may not be possible or wise to provide adequate nutritional requirements via this route. …