Introduction
critically ill, immune deficiencies, reduced organ dysfunction, septic shock, sepsis
SEPSIS, CRITICALLY ILL, SEPTIC SHOCK
Several observations indicate that a significant proportion of patients admitted to the intensive care unit (ICU) will develop temporary immune deficiencies [Although the results have been confounded by grouping different formulas and different types of patients together, harmful effects have been suspected from the use of L-arginine-containing formulas in critically ill patients, especially in patients with sepsis or septic shock [We aimed to evaluate whether L-citrulline administration reduced organ dysfunction as defined by the SOFA score and whether it affected selected immune parameters associated with outcomes, such as interleukin (IL)-6 and monocytic expression of HLA-DR, in mechanically ventilated medical ICU patients. Therefore, we conducted an enteral nutrition intervention study comparing standard enteral nutrition enriched with L-citrulline with standard enteral nutrition plus isonitrogenous isocaloric placebo in mechanically ventilated critically ill patients without sepsis or septic shock.