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Review
. 2023 Apr;72(4):229-244.
doi: 10.1007/s00101-023-01258-4. Epub 2023 Feb 16.

[Immunomodulation by nutritional intervention in critically ill patients]

[Article in German]
Simon Hirschberger  1   2 , Annika Schmid  1   2 , Simone Kreth  3   4
Affiliations
Review

[Immunomodulation by nutritional intervention in critically ill patients]

[Article in German]
Simon Hirschberger et al. Anaesthesiologie. 2023 Apr.

Abstract
in English, German

Critically ill patients often suffer from a complex and severe immunological dysfunction. The differentiation and function of human immune cells are fundamentally controlled through metabolic processes. New concepts of immunonutrition therefore try to use enteral and parenteral nutrition to positively impact on the immune function of intensive care unit patients. This review article concisely presents the currently available evidence on the commonly used isolated supplements (anti-oxidative substances, amino acids, essential fatty acids) and difficulties related to their clinical use. The second part presents new and more comprehensive concepts of immunonutrition to influence the intestinal microbiome and to modulate the macronutrient composition. Immunonutrition of critically ill patients bears enormous potential and could become a valuable clinical tool for modulation of the immunometabolism of intensive care unit patients.

Kritisch kranke Patienten leiden häufig unter einer komplexen und schwerwiegenden immunologischen Dysfunktion. Die Differenzierung und Funktion von Immunzellen werden maßgeblich durch metabolische Prozesse gesteuert. Neue immunonutritive Konzepte versuchen daher, die Immunfunktionen intensivmedizinischer Patienten über enterale und parenterale Ernährung positiv zu beeinflussen. Die vorliegende Übersichtsarbeit präsentiert kondensiert die verfügbare Evidenz zu den gängigen isolierten Supplementen (antioxidative Substanzen, Aminosäuren, essenzielle Fettsäuren) und die damit verbundenen Problematiken. Im zweiten Teil werden sich daraus ergebende neuartige und umfassendere Konzepte der Immunonutrition zur Beeinflussung des intestinalen Mikrobioms und zur Modulation der Makronährstoffkomposition vorgestellt. Die Immunonutrition des kritisch kranken Patienten hat enormes Potenzial und kann sich zukünftig zu einem wertvollen klinischen Tool zur Modulation des Immunmetabolismus intensivmedizinischer Patienten entwickeln.

Keywords: Immunometabolic paralysis; Immunonutrition; Ketogenic diet; Macronutrients; Microbiome.

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References

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