Supplémentation en l-arginine en réanimation

A meta-analysis has demonstrated the beneficial effect of immunonutrition in surgical patients, leading to half reduction of incidence of nosocomial infections and promoting wound healing. This beneficial effect seems to be related to l-arginine content of formula. l-arginine is a semi-essential amino acid that is the precursor of nitric oxide (NO) synthesis. NO is involved in immune response regulation and has antimicrobial properties. In medical intensive care, such an improvement has not been shown, in spite of similar impairment of immune response, which could be due to a more heterogeneous population. However, arginine supplementation is capable of promoting an increase in NO production which may have an adverse effect in septic patients. Nevertheless, beneficial effect of arginine supplementation could be observed in selected patients of medical intensive care units.