Quel pharmaconutriment choisir en réanimation ?

Abstract: Thanks to a better knowledge of specific metabolic needs in the critically ill patient, clinical trials have been performed to assess the clinical efficacy of supplementation with specific substrates used as pharmaconutrients. Main pharmaconutrients of potential interest in the ICU are glutamine, arginine, n-3 polyinsaturated fatty acids and anti-oxidants. Their clinical usefulness, which varies according to the dose, the route of supplementation, and to patients categories (surgical, trauma, burned, septic...), and their underlying mechanisms of action are now better defined. After reviewing the main pathophysiological targets of each pharmaconutrient in the critically ill patient, this paper summarizes for each substrate their validated or potential indications. Beyond nutritional support, pharmaconutrition appears nowadays as a true therapeutic means in the critically ill patient. [Copyright &y& Elsevier]