Critical Illness

CI: Immune-Modulating Enteral Nutrition (2006)

• Intervention
  Does the addition of immune-modulating enteral nutrition to enteral feeding of severely ill ICU patients impact mortality?

  • Conclusion

    The addition of immune-modulating EN to enteral feeding of severely ill ICU patients may be associated with increased mortality, though adequately powered trials have not been conducted.   

     

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Does the addition of immune-enhancing enteral nutrition to enteral feeding of ICU patients impact mortality?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Atkinson S, Sieffert E, Bihari D. A prospective, randomized, double blind, controlled clinical trial of enteral immunonutrition in the critically ill. Critical Care Medicine, Vol 26(7) July 1998: 1164-1172
      • Beale RJ, Bryg DJ, Bihari, MB. Immunonutrition in the critically ill:  a systematic review of clinical out.  Critical Care Med.  1999 vol 27(12)  pp 2799-2805
      • Bertolini G, Iapichino G, Radrizzani D, Facchini B, Simini B, Bruzzone P, Zanforlin G, Tognoni G. Early enteral immunonutrition in patients with severe sepsis.  Intensive Care Medicine. 29:834-840, 2003.
      • Bower, RH, Cerra FB, Bershadsky B, Licari, JJ, Hoyt DB, Jensen GL, Van Buren CT, Rothkpf MM, Daly JM, Adelsberg BR. Early enteral administration of a formula (Impact Registered Trademark) supplemented with arginine, nucleotides, and fish oil intensive care unit patients: Results of a multicenter, prospective, randomized, clinical trial. Critical Care Medicine, Volue 23(3) March 1995 pp 436-449.
      • Caparros T, Lopez J, Grau T.  Early enteral nutrition in critically ill patients with a high-protien diet enriched with arginine, fiber, and antioxidants compared with a standard high-protein diet.  The effect on nosocomial infections and outcome.  J Parenter Enteral Nutr.  25(6): 299-308. 2001 
      • Cerra FB, Lehman S, Konstantinides N, Konstantinides F, Shronts EP, Holman R. Effect of enteral nutrient on in vitro tests of immune function in ICU patients:  A preliminary report. Nutrition. 6(1):84-87, 1990.
      • Galban, C., Montejo, J.C., Mesejo,P.,Celaya,S., Sandchez-Segura, J., Farre, M., Bryg, D.J., An immune-enhancing enteral diet reduces mortality rate adn episodes of bacterimia in septic intensive care unit patients. Critical Care Medicine, Vol 28(3) pp643-648. 2000.
      • Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN. 2003; 27: 355-373.
      • Heyland DK, Novak F, Drover JW, Jain M, Su X, Suchner U. Should Immunonutrition become routine in critically ill patients? A systematic review of the evidence. (Caring for the critically ill patients). JAMA 2001; 286 p944.
      • Heys SD, Walker LG, Smith I, Eremin O. Enteral nutritional supplementation with key nutrients in patients with critical illness and cancer; a meta-analysis randomized controlled clinical trials. Annals Surgery, vol 229 (4), 1999 pp467-477.
      • Kieft H, Roos AN, van Drunen JDE, Bindels AJGH,  Bindels JG, Hofman Z. Clinical outcomes of immunonutrition in a heterogeneous intensive care population. Intensive Care Med (2005) 31:524-532.
      • Montejo JC, Zarazaga A, Lopez-Martinez J, Urrutia G, Roque M, Blesa AL, Celaya S, Conejero R, Galban C, Garcia de Lorenzo A, Grau T, Mesejo A, Ortiz-Leyba C, Planas M, Ordonez J, Jimenez FJ. Immunonutrition in the intensive care unit.  A systematic review and consensus statement. Clinical Nutrition. 22(3):221-233, 2003.
      • Moore FA, Moore EE, Kudsk KA, Brown RO, Bower RH, Koruda MJ, Baker CC, Barbul A. Clinical benefits of an immune-enhancing diet for early post injury enteral feeding. J Trauma 37:607-615, 1994.
      • Weimann A, Bastian L, Bischoff W, Grotz M, Hansel M, Lotz J, Trautwein C, Tusch G, Schlitt HJ, Regel G. Influence of Arginine, Omega-3 Fatty Acids and Nucleotide-Supplemented Enteral Support on Systemic Inflammatory Response Syndrome and Multiple Organ Failure in Patients After Sever Trauma. Nutrition 14:165-172, 1998.
  • Search Plan and Results: CI: Immune-Enhancing Enteral Nutrition 2005
     
  Does the addition of immune-modulating enteral nutrition to enteral feeding of moderate to less severely ill ICU patients impact mortality?

  • Conclusion

    The addition of immune-modulating EN to enteral feeding of moderate or less severely ill ICU patients demonstrates no effect on mortality.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Does the addition of immune-enhancing enteral nutrition to enteral feeding of ICU patients impact mortality?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Atkinson S, Sieffert E, Bihari D. A prospective, randomized, double blind, controlled clinical trial of enteral immunonutrition in the critically ill. Critical Care Medicine, Vol 26(7) July 1998: 1164-1172
      • Beale RJ, Bryg DJ, Bihari, MB. Immunonutrition in the critically ill:  a systematic review of clinical out.  Critical Care Med.  1999 vol 27(12)  pp 2799-2805
      • Bertolini G, Iapichino G, Radrizzani D, Facchini B, Simini B, Bruzzone P, Zanforlin G, Tognoni G. Early enteral immunonutrition in patients with severe sepsis.  Intensive Care Medicine. 29:834-840, 2003.
      • Bower, RH, Cerra FB, Bershadsky B, Licari, JJ, Hoyt DB, Jensen GL, Van Buren CT, Rothkpf MM, Daly JM, Adelsberg BR. Early enteral administration of a formula (Impact Registered Trademark) supplemented with arginine, nucleotides, and fish oil intensive care unit patients: Results of a multicenter, prospective, randomized, clinical trial. Critical Care Medicine, Volue 23(3) March 1995 pp 436-449.
      • Caparros T, Lopez J, Grau T.  Early enteral nutrition in critically ill patients with a high-protien diet enriched with arginine, fiber, and antioxidants compared with a standard high-protein diet.  The effect on nosocomial infections and outcome.  J Parenter Enteral Nutr.  25(6): 299-308. 2001 
      • Cerra FB, Lehman S, Konstantinides N, Konstantinides F, Shronts EP, Holman R. Effect of enteral nutrient on in vitro tests of immune function in ICU patients:  A preliminary report. Nutrition. 6(1):84-87, 1990.
      • Galban, C., Montejo, J.C., Mesejo,P.,Celaya,S., Sandchez-Segura, J., Farre, M., Bryg, D.J., An immune-enhancing enteral diet reduces mortality rate adn episodes of bacterimia in septic intensive care unit patients. Critical Care Medicine, Vol 28(3) pp643-648. 2000.
      • Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN. 2003; 27: 355-373.
      • Heyland DK, Novak F, Drover JW, Jain M, Su X, Suchner U. Should Immunonutrition become routine in critically ill patients? A systematic review of the evidence. (Caring for the critically ill patients). JAMA 2001; 286 p944.
      • Heys SD, Walker LG, Smith I, Eremin O. Enteral nutritional supplementation with key nutrients in patients with critical illness and cancer; a meta-analysis randomized controlled clinical trials. Annals Surgery, vol 229 (4), 1999 pp467-477.
      • Kieft H, Roos AN, van Drunen JDE, Bindels AJGH,  Bindels JG, Hofman Z. Clinical outcomes of immunonutrition in a heterogeneous intensive care population. Intensive Care Med (2005) 31:524-532.
      • Montejo JC, Zarazaga A, Lopez-Martinez J, Urrutia G, Roque M, Blesa AL, Celaya S, Conejero R, Galban C, Garcia de Lorenzo A, Grau T, Mesejo A, Ortiz-Leyba C, Planas M, Ordonez J, Jimenez FJ. Immunonutrition in the intensive care unit.  A systematic review and consensus statement. Clinical Nutrition. 22(3):221-233, 2003.
      • Moore FA, Moore EE, Kudsk KA, Brown RO, Bower RH, Koruda MJ, Baker CC, Barbul A. Clinical benefits of an immune-enhancing diet for early post injury enteral feeding. J Trauma 37:607-615, 1994.
      • Weimann A, Bastian L, Bischoff W, Grotz M, Hansel M, Lotz J, Trautwein C, Tusch G, Schlitt HJ, Regel G. Influence of Arginine, Omega-3 Fatty Acids and Nucleotide-Supplemented Enteral Support on Systemic Inflammatory Response Syndrome and Multiple Organ Failure in Patients After Sever Trauma. Nutrition 14:165-172, 1998.
  • Search Plan and Results: CI: Immune-Enhancing Enteral Nutrition 2005
     
  Does the addition of immune-modulating enteral nutrition to enteral feeding impact infectious complications in critically ill ICU patients?

  • Conclusion

    The use of immune-modulating EN in some critically ill ICU patients has shown benefit in reducing infectious complications in some patients.

     

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Does the addition of immune-enhancing enteral nutrition to enteral feeding impact infectious complications in critically ill ICU patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Beale RJ, Bryg DJ, Bihari, MB. Immunonutrition in the critically ill:  a systematic review of clinical out.  Critical Care Med.  1999 vol 27(12)  pp 2799-2805
      • Bower, RH, Cerra FB, Bershadsky B, Licari, JJ, Hoyt DB, Jensen GL, Van Buren CT, Rothkpf MM, Daly JM, Adelsberg BR. Early enteral administration of a formula (Impact Registered Trademark) supplemented with arginine, nucleotides, and fish oil intensive care unit patients: Results of a multicenter, prospective, randomized, clinical trial. Critical Care Medicine, Volue 23(3) March 1995 pp 436-449.
      • Brown RO, Hunt H, Mowatt-Larssen CA, Wojtysiak SL, Henningfield MF, Kudsk KA. Comparison of specialized and standard enteral formulas in trauma patients.  Pharmacotherapy. 14(3):314-320, 1994.
      • Caparros T, Lopez J, Grau T.  Early enteral nutrition in critically ill patients with a high-protien diet enriched with arginine, fiber, and antioxidants compared with a standard high-protein diet.  The effect on nosocomial infections and outcome.  J Parenter Enteral Nutr.  25(6): 299-308. 2001 
      • Galban, C., Montejo, J.C., Mesejo,P.,Celaya,S., Sandchez-Segura, J., Farre, M., Bryg, D.J., An immune-enhancing enteral diet reduces mortality rate adn episodes of bacterimia in septic intensive care unit patients. Critical Care Medicine, Vol 28(3) pp643-648. 2000.
      • Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN. 2003; 27: 355-373.
      • Heyland DK, Novak F, Drover JW, Jain M, Su X, Suchner U. Should Immunonutrition become routine in critically ill patients? A systematic review of the evidence. (Caring for the critically ill patients). JAMA 2001; 286 p944.
      • Heys SD, Walker LG, Smith I, Eremin O. Enteral nutritional supplementation with key nutrients in patients with critical illness and cancer; a meta-analysis randomized controlled clinical trials. Annals Surgery, vol 229 (4), 1999 pp467-477.
      • Kieft H, Roos AN, van Drunen JDE, Bindels AJGH,  Bindels JG, Hofman Z. Clinical outcomes of immunonutrition in a heterogeneous intensive care population. Intensive Care Med (2005) 31:524-532.
      • Kudsk KA, Minard G, Croce MA, Brown RO. Lowrey TS, Pritchard FE, Dickerson RN, Fabian TC. A randomized trial of isonitrogenous enteral diets after severe trauma: an immune-enhancing diet reduces septic complications. Ann Surg. 1996: 224 (4); 531-543.
      • Montejo JC, Zarazaga A, Lopez-Martinez J, Urrutia G, Roque M, Blesa AL, Celaya S, Conejero R, Galban C, Garcia de Lorenzo A, Grau T, Mesejo A, Ortiz-Leyba C, Planas M, Ordonez J, Jimenez FJ. Immunonutrition in the intensive care unit.  A systematic review and consensus statement. Clinical Nutrition. 22(3):221-233, 2003.
      • Moore FA, Moore EE, Kudsk KA, Brown RO, Bower RH, Koruda MJ, Baker CC, Barbul A. Clinical benefits of an immune-enhancing diet for early post injury enteral feeding. J Trauma 37:607-615, 1994.
      • Weimann A, Bastian L, Bischoff W, Grotz M, Hansel M, Lotz J, Trautwein C, Tusch G, Schlitt HJ, Regel G. Influence of Arginine, Omega-3 Fatty Acids and Nucleotide-Supplemented Enteral Support on Systemic Inflammatory Response Syndrome and Multiple Organ Failure in Patients After Sever Trauma. Nutrition 14:165-172, 1998.
  • Search Plan and Results: CI: Immune-Enhancing Enteral Nutrition 2005
     
  Does the addition of immune-modulating enteral nutrition to enteral feeding impact length of hospital stay in critically ill ICU patients?

  • Conclusion

    The addition of immune-modulating EN to enteral feeding of critically ill ICU patients has limited impact on LOS.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Does the addition of immune-enhancing enteral nutrition to enteral feeding impact length of hospital stay in critically ill ICU patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Atkinson S, Sieffert E, Bihari D. A prospective, randomized, double blind, controlled clinical trial of enteral immunonutrition in the critically ill. Critical Care Medicine, Vol 26(7) July 1998: 1164-1172
      • Beale RJ, Bryg DJ, Bihari, MB. Immunonutrition in the critically ill:  a systematic review of clinical out.  Critical Care Med.  1999 vol 27(12)  pp 2799-2805
      • Bertolini G, Iapichino G, Radrizzani D, Facchini B, Simini B, Bruzzone P, Zanforlin G, Tognoni G. Early enteral immunonutrition in patients with severe sepsis.  Intensive Care Medicine. 29:834-840, 2003.
      • Bower, RH, Cerra FB, Bershadsky B, Licari, JJ, Hoyt DB, Jensen GL, Van Buren CT, Rothkpf MM, Daly JM, Adelsberg BR. Early enteral administration of a formula (Impact Registered Trademark) supplemented with arginine, nucleotides, and fish oil intensive care unit patients: Results of a multicenter, prospective, randomized, clinical trial. Critical Care Medicine, Volue 23(3) March 1995 pp 436-449.
      • Brown RO, Hunt H, Mowatt-Larssen CA, Wojtysiak SL, Henningfield MF, Kudsk KA. Comparison of specialized and standard enteral formulas in trauma patients.  Pharmacotherapy. 14(3):314-320, 1994.
      • Caparros T, Lopez J, Grau T.  Early enteral nutrition in critically ill patients with a high-protien diet enriched with arginine, fiber, and antioxidants compared with a standard high-protein diet.  The effect on nosocomial infections and outcome.  J Parenter Enteral Nutr.  25(6): 299-308. 2001 
      • Cerra FB, Lehman S, Konstantinides N, Konstantinides F, Shronts EP, Holman R. Effect of enteral nutrient on in vitro tests of immune function in ICU patients:  A preliminary report. Nutrition. 6(1):84-87, 1990.
      • Galban, C., Montejo, J.C., Mesejo,P.,Celaya,S., Sandchez-Segura, J., Farre, M., Bryg, D.J., An immune-enhancing enteral diet reduces mortality rate adn episodes of bacterimia in septic intensive care unit patients. Critical Care Medicine, Vol 28(3) pp643-648. 2000.
      • Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN. 2003; 27: 355-373.
      • Heyland DK, Novak F, Drover JW, Jain M, Su X, Suchner U. Should Immunonutrition become routine in critically ill patients? A systematic review of the evidence. (Caring for the critically ill patients). JAMA 2001; 286 p944.
      • Heys SD, Walker LG, Smith I, Eremin O. Enteral nutritional supplementation with key nutrients in patients with critical illness and cancer; a meta-analysis randomized controlled clinical trials. Annals Surgery, vol 229 (4), 1999 pp467-477.
      • Kieft H, Roos AN, van Drunen JDE, Bindels AJGH,  Bindels JG, Hofman Z. Clinical outcomes of immunonutrition in a heterogeneous intensive care population. Intensive Care Med (2005) 31:524-532.
      • Kudsk KA, Minard G, Croce MA, Brown RO. Lowrey TS, Pritchard FE, Dickerson RN, Fabian TC. A randomized trial of isonitrogenous enteral diets after severe trauma: an immune-enhancing diet reduces septic complications. Ann Surg. 1996: 224 (4); 531-543.
      • Montejo JC, Zarazaga A, Lopez-Martinez J, Urrutia G, Roque M, Blesa AL, Celaya S, Conejero R, Galban C, Garcia de Lorenzo A, Grau T, Mesejo A, Ortiz-Leyba C, Planas M, Ordonez J, Jimenez FJ. Immunonutrition in the intensive care unit.  A systematic review and consensus statement. Clinical Nutrition. 22(3):221-233, 2003.
      • Moore FA, Moore EE, Kudsk KA, Brown RO, Bower RH, Koruda MJ, Baker CC, Barbul A. Clinical benefits of an immune-enhancing diet for early post injury enteral feeding. J Trauma 37:607-615, 1994.
      • Weimann A, Bastian L, Bischoff W, Grotz M, Hansel M, Lotz J, Trautwein C, Tusch G, Schlitt HJ, Regel G. Influence of Arginine, Omega-3 Fatty Acids and Nucleotide-Supplemented Enteral Support on Systemic Inflammatory Response Syndrome and Multiple Organ Failure in Patients After Sever Trauma. Nutrition 14:165-172, 1998.
  • Search Plan and Results: CI: Immune-Enhancing Enteral Nutrition 2005
     
  Does the addition of immune-modulating enteral nutrition to enteral feeding impact days on mechanical ventilation in critically ill ICU patients?

  • Conclusion

    The addition of immune-modulating EN to enteral feeding of critically ill ICU patients is not associated with reduced number of days on mechanical ventilation.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Does the addition of immune-enhancing enteral nutrition to enteral feeding impact days on mechanical ventilation in critically ill ICU patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Atkinson S, Sieffert E, Bihari D. A prospective, randomized, double blind, controlled clinical trial of enteral immunonutrition in the critically ill. Critical Care Medicine, Vol 26(7) July 1998: 1164-1172
      • Beale RJ, Bryg DJ, Bihari, MB. Immunonutrition in the critically ill:  a systematic review of clinical out.  Critical Care Med.  1999 vol 27(12)  pp 2799-2805
      • Galban, C., Montejo, J.C., Mesejo,P.,Celaya,S., Sandchez-Segura, J., Farre, M., Bryg, D.J., An immune-enhancing enteral diet reduces mortality rate adn episodes of bacterimia in septic intensive care unit patients. Critical Care Medicine, Vol 28(3) pp643-648. 2000.
      • Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN. 2003; 27: 355-373.
      • Kieft H, Roos AN, van Drunen JDE, Bindels AJGH,  Bindels JG, Hofman Z. Clinical outcomes of immunonutrition in a heterogeneous intensive care population. Intensive Care Med (2005) 31:524-532.
      • Kudsk KA, Minard G, Croce MA, Brown RO. Lowrey TS, Pritchard FE, Dickerson RN, Fabian TC. A randomized trial of isonitrogenous enteral diets after severe trauma: an immune-enhancing diet reduces septic complications. Ann Surg. 1996: 224 (4); 531-543.
      • Montejo JC, Zarazaga A, Lopez-Martinez J, Urrutia G, Roque M, Blesa AL, Celaya S, Conejero R, Galban C, Garcia de Lorenzo A, Grau T, Mesejo A, Ortiz-Leyba C, Planas M, Ordonez J, Jimenez FJ. Immunonutrition in the intensive care unit.  A systematic review and consensus statement. Clinical Nutrition. 22(3):221-233, 2003.
      • Moore FA, Moore EE, Kudsk KA, Brown RO, Bower RH, Koruda MJ, Baker CC, Barbul A. Clinical benefits of an immune-enhancing diet for early post injury enteral feeding. J Trauma 37:607-615, 1994.
      • Weimann A, Bastian L, Bischoff W, Grotz M, Hansel M, Lotz J, Trautwein C, Tusch G, Schlitt HJ, Regel G. Influence of Arginine, Omega-3 Fatty Acids and Nucleotide-Supplemented Enteral Support on Systemic Inflammatory Response Syndrome and Multiple Organ Failure in Patients After Sever Trauma. Nutrition 14:165-172, 1998.
  • Search Plan and Results: CI: Immune-Enhancing Enteral Nutrition 2005
     
  Does the addition of immune-modulating enteral nutrition to enteral feeding impact cost of medical care in critically ill ICU patients?

  • Conclusion

    The addition of immune-modulating EN to enteral feeding of critically ill ICU patients is not associated with reduced cost of medical care.  

     

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Does the addition of immune-enhancing enteral nutrition to enteral feeding impact cost of medical care in critically ill ICU patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Kudsk KA, Minard G, Croce MA, Brown RO. Lowrey TS, Pritchard FE, Dickerson RN, Fabian TC. A randomized trial of isonitrogenous enteral diets after severe trauma: an immune-enhancing diet reduces septic complications. Ann Surg. 1996: 224 (4); 531-543.
      • Montejo JC, Zarazaga A, Lopez-Martinez J, Urrutia G, Roque M, Blesa AL, Celaya S, Conejero R, Galban C, Garcia de Lorenzo A, Grau T, Mesejo A, Ortiz-Leyba C, Planas M, Ordonez J, Jimenez FJ. Immunonutrition in the intensive care unit.  A systematic review and consensus statement. Clinical Nutrition. 22(3):221-233, 2003.
  • Search Plan and Results: CI: Immune-Enhancing Enteral Nutrition 2005