Comparasion between effects of nutritional immunomodulation with glutamine: An integral part of the treatment of critically ill: Trend and perspective (immunonitrition in critically ill patients)

In the last few decades the advanced technology significantly changed the treatment of critically ill patients. Mechanical ventilation, transfusion of blood products, renal replacement therapy, invasive monitoring and many other procedures drastically prolonged and changed life, modulating homeostasis, developing new pathways and mechanisms of adaptation - allostasis. Systemic inflammatory response and immunomodulatory activity are a part of complex underlying mechanisms involved in allostasis. Based on recently published results of certain studies, a few nutrients (omega-3 fatty acids, arginine, glutamine) added to the standard formula for enteral and parenteral nutrition, reduced ICU stay and rate of infection as well as duration of mechanical ventilation in critically ill patients. Glutamine, 'essential' nonessential amino acid has high immunomodulatory capacity, as fuel for muscles and 'shuttle' for nitrogen, protecting lung and gut function as well as the function of immunocompetent cells. Despite that there is no universally accepted strategy concerning nutritional immunomodulation, it is implemented in ASPEN and ESPEN guidelines.