Alternative lipid emulsions in the critically ill: a systematic review of the evidence

Abstract

Introduction Parenteral lipid emulsions (LEs) are commonly rich in long-chain triglycerides (LCT) derived from soybean oil (SO). SO containing emulsions may promote systemic inflammation and therefore may adversely affect clinical outcomes. We hypothesized that alternative oil-based LEs (SO-sparing strategies) may improve clinical outcomes in critically ill adult patients compared to SO emulsion only products. The purpose of this systematic review was to evaluate the effect of parenteral SO-sparing strategies on clinical outcomes in intensive care unit (ICU) patients. Methods We searched computerized databases from 1980 to 2013. We included randomized controlled trials (RCTs) conducted in critically ill adult patients that evaluated SO-sparing strategies versus SO-based LEs in the context of parenteral nutrition (PN). Results A total of 12 RCTs met inclusion criteria. When the results of these RCTs that were statistically aggregated, SO-sparing strategies were associated with clinically important reductions in mortality (risk ratio RR= 0.83, 95% confidence intervals CI 0.62, 1.11, P = 0.20), in duration of ventilation (weighted mean difference, WMD −2.57, 95% CI −5.51, 0.37, P= 0.09), and in ICU length of stay (WMD −2.31, 95% CI −5.28, 0.66, P= 0.13) but none of these differences were statistically significant. SO-sparing strategies had no effect on infectious complications (RR=1.13, 95% CI 0.87, 1.46, P=0.35). Conclusion Alternative oil-based LEs may be associated with clinically important reductions in mortality, duration of ventilation, and ICU LOS but lack of statistical precision precludes any clinical recommendations at this time. Further research is warranted to confirm these potential positive treatment effects.

Fishing for Improved Outcomes in the Critically Ill*

“…A more recent meta-analysis (11) combined all SO-sparing lipid emulsions (i.e., those containing MCT, OO or fish oil alone, or in any combination) for comparison with SO and demonstrated trends for improved clinical outcomes (days of ventilation, ICU stay, and mortality) with SO sparing. Subgroup analyses compared SO with SO-MCT, fish oil with SO or SO-MCT, and 00 with SO-MCT (11). There were no differences in outcome between SO and SO-MCT.…”

The Role of Fish Oil Feeding Rich in ω‐3 Polyunsaturated Fatty Acids in Patients with Sepsis and Septic Shock

“…In a recent systematic review of 12 RCTS including 806 patients by Manzanares and colleagues, no significant difference in outcome benefits was found [56]. In another meta-analysis of eight RCTS involving 391 patients by Palmer et al [52], a significant reduction in hospital length of stay was demonstrated by nearly 10 days in those receiving ω-3 fish oil in relation with either SO-based or SO + MCT-based lipid emulsions.…”

Year in review in Intensive Care Medicine 2013: I. Acute kidney injury, ultrasound, hemodynamics, cardiac arrest, transfusion, neurocritical care, and nutrition

“…When enteral feeding is not achievable, parenteral nutrition is indicated. Manzanares et al [80] systematically compared the use of alternative intravenous lipid emulsions to the use of soya-based lipid emulsions. Twelve RCTs were analyzed and statistically aggregated.…”