Key words: omega-3 fatty acid; fish oil; soybean oil; immunonutrition; inflammation; acute-phase response; parenteral nutritionEpidemiologic studies have indicated that high intake of saturated fat and/or animal fat increases the risk of colon and breast cancers. 1 Further laboratory experiments showed reduced risk of colon carcinogenesis after omega-3 PUFA supplementation. In a phase II clinical trial of patients with colonic polyps, dietary FO supplements inhibited cell proliferation. Mechanisms accounting for the antitumour effects in animal models are reduced levels of PGE 2 and inducible NO synthase as well as increased lipid peroxidation or translation inhibition and subsequent cell-cycle arrest. 2 In patients with advanced cancer, weight loss is a major cause of morbidity and mortality. While it is possible to increase energy and protein intake on the enteral or parenteral route, this appears to have little impact on patients' progressive weight loss. 3 Clinical studies in the last few years have provided evidence for beneficial effects of FO administration in cancer cachexia 4 and during radioand chemotherapy. 5 Omega-3 EPA is capable of downregulating the production and action of a number of mediators of cachexia, e.g., IL-1, IL-6, TNF-␣ and proteolysis-inducing factor. 6,7 However, SO (omega-6) emulsions appear to impede tumoricidal activity compared to EPA. 8 Beyond the beneficial effects of long-term intake of omega-3 PUFA in cancer patients, we likewise observed rapid-onset effects in previous experimental studies. Compared to SO emulsion, we found decreased inflammatory pulmonary vascular response in isolated rabbit lungs after omega-3 PUFA infusion. 9 Lung edema formation was blunted because proinflammatory 4-series leukotrienes were shifted to less inflammatory 5-series leukotrienes and, consequently, pulmonary vascular resistance and permeability were reduced. 9 These rapid effects of omega-3 PUFA were confirmed in patients with acute respiratory distress syndrome, showing improved pulmonary function within a few days on an omega-3 fatty acid-enriched diet. 10 The background of these beneficial effects was reduced release of proinflammatory AA derivatives. 11 Following major abdominal nonliver surgery, increases in ALAT were observed and correlated with ultrastructural damage of the liver. 12 In the postoperative course after major abdominal surgery, intact liver function is crucial not only for energy balance (glucose and lactate metabolism) but also for providing several humoral factors, which induce, support and ultimately terminate regenerative mechanisms. This APR of the liver sets off immediately after the (surgical) trauma and upregulates coagulation factors and proteinase inhibitors for wound healing and complement components and opsonins (e.g., CRP) for early bactericidal activity at the site of trauma. 13

The focus of this paper is to identify and quantify risk factors for early hemorrhagic progression of brain contusions (HPC) in patients with traumatic brain injury (TBI) and to evaluate their impact on patients' outcome. Further, based on abnormal values in routine blood tests, the role of trauma-induced coagulopathy is analyzed in detail. Therefore, a prospective study of 153 TBI patients was completed at one institution between January 2008 and June 2012. The collected data included demographics, initial Glasgow Coma Scale pupillary response, initial and 6 h follow-up computed tomography scan findings, coagulation parameters (international normalized ratio, partial thromboplastin time, platelet count, fibrinogen, D-dimer and factor XIII), as well as outcome data using the modified Rankin score at discharge and after one year. The overall rate of early HPC within the first 6 h was 43.5%. The frequency of coagulopathy was 47.1%. When analyzing for risk factors that independently influenced outcome in the form of mRS ≥4 at both points, the following variables appeared: elevated D-dimer level (≥10,000 μg/L), HPC, and initial brain contusions ≥3 cm. Patients sustaining early HPC had a hazard ratio of 5.4 for unfavorable outcome at discharge (p=0.002) and of 3.9 after one year (p=0.006). Overall, patients who developed early HPC were significantly more likely to be gravely disabled or to die. Unfavorable neurological outcome after an isolated TBI is determined largely by early HPC and coagulopathy, which seem to occur very frequently in TBI patients, irrespective of the severity of the trauma.

Decannulation was achieved in 59.4% of stroke patients surviving the first 12 months after tracheostomy and was associated with better functional outcome compared to patients without decannulation. Further prospective studies with larger sample sizes are needed to confirm our results.

IntroductionThis study aims at comparing the very short-term effects of conventional and noisy (variable) pressure support ventilation (PSV) in mechanically ventilated patients with acute hypoxemic respiratory failure.MethodsThirteen mechanically ventilated patients with acute hypoxemic respiratory failure were enrolled in this monocentric, randomized crossover study. Patients were mechanically ventilated with conventional and noisy PSV, for one hour each, in random sequence. Pressure support was titrated to reach tidal volumes approximately 8 mL/kg in both modes. The level of positive end-expiratory pressure and fraction of inspired oxygen were kept unchanged in both modes. The coefficient of variation of pressure support during noisy PSV was set at 30%. Gas exchange, hemodynamics, lung functional parameters, distribution of ventilation by electrical impedance tomography, breathing patterns and patient-ventilator synchrony were analyzed.ResultsNoisy PSV was not associated with any adverse event, and was well tolerated by all patients. Gas exchange, hemodynamics, respiratory mechanics and spatial distribution of ventilation did not differ significantly between conventional and noisy PSV. Noisy PSV increased the variability of tidal volume (24.4 ± 7.8% vs. 13.7 ± 9.1%, P <0.05) and was associated with a reduced number of asynchrony events compared to conventional PSV (5 (0 to 15)/30 min vs. 10 (1 to 37)/30 min, P <0.05).ConclusionsIn the very short term, noisy PSV proved safe and feasible in patients with acute hypoxemic respiratory failure. Compared to conventional PSV, noisy PSV increased the variability of tidal volumes, and was associated with improved patient-ventilator synchrony, at comparable levels of gas exchange.Trial registrationClinicialTrials.gov, NCT00786292

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