Aim: Critical ill patients experience catabolic stress which results in the systemic inflammatory response. The inflammatory response is associated with increased complications including infection, multi-organ dysfunction, increased length of ICU stays, and mortality. L-Carnitine supplementation may play an important role in these patients by regulating inflammatory cell function. The purpose of the present study was to investigate the effect of L-Carnitine supplementation on clinical status, inflammatory markers, and mortality rate in critically ill patients admitted in the intensive care unit(ICU) Methods: This randomized, double-blind, placebo-controlled trial was performed on critically ill patients. Subjects were randomly assigned into placebo (n=27) and L-Carnitine (n=27) groups. L-Carnitine (3000mg/day) was administered via nasogastric tube for the intervention group for 7 days while the other group received a placebo for the same duration. Serum levels of inflammatory markers including C-reactive protein (CRP) and interleukin-6 (IL-6) were measured. Nutritional status and the acute physiology and chronic health evaluation (APACHE) score, sequential organ failure assessment (SOFA) score, and 28-day mortality were also recorded. Results: Fifty-one critically ill patients completed the study. L-Carnitine supplementation significantly reduced the levels of CRP (mean change± SE: -34.9 ± 6.5) and IL-6 (mean change ±SE: -10.64 ± 2.16) compared to the baseline, which are both statistically significant compared with the control group (p<0.05). The SOFA and APACHE scores were significantly reduced in the L-Carnitine group compared with the placebo group (p=0.02 and p<0.001, respectively). Conclusions: L-Carnitine supplementation has substantial beneficial effects on inflammatory and clinical outcomes of critically ill patients.

Aim: In Traumatic brain injury (TBI) patients, a complex cascade of inflammatory responses is frequently observed following trauma. Numerous dietary agents have long been found to have potential in modulating inflammatory responses. This pilot study, designed an enteral formula with low inflammatory properties based on the dietary inflammatory index (DII®) and evaluated its effect on inflammatory and metabolic factors in critically ill TBI patients. Methods: This Single-blind randomized controlled pilot study conducted at the Neurosurgical ICU of Shahid Kamyab Hospital (Mashhad, Iran). A total of 20 TBI patients were randomly assigned to receive either low-DII-score or standard formula at the Intensive Care Unit (ICU). The primary outcomes of the study included clinical status, inflammatory biomarkers, APACHE II, SAPS II, SOFA, and NUTRIC scores. Results: The trial groups did not differ significantly on baseline values. Following 14 days of intervention, there was a statistically significant decrease in the APACHE II, SAPS II, and NUTRIC scores and a significant increase in GCS score in the low-DII-score formula group compared to the standard formula group. Over two weeks, high sensitivity c-reactive protein (hs-CRP) values -2.73 (95% CI: -3.67, -1.79) mg/dL in the low-DII-score formula group vs. 0.65 (95% CI: -0.29, 1.58) mg/dL in controls. Moreover, the length of hospital stay was longer for the standard formula group than for the low-DII-score formula group. Conclusion: The low-DII-score formula improves inflammatory factors (serum hs-CRP) and metabolic biomarkers (LDL-c and FBS). Furthermore, clinical outcomes, including the length of hospital stay and disease severity appear to be enhanced.