Fish oil after abdominal aorta aneurysm surgery

Abstract

Objective: Fish oil (FO) may attenuate the inflammatory response after major surgery such as abdominal aortic aneurysm (AAA) surgery. We aimed at evaluating the clinical impact and safety aspects of a FO containing parenteral nutrition (PN) after AAA surgery. Methods: Intervention consisted in 4 days of either standard (STD: Lipofundin medium-chain triglyceride (MCT): long-chain triglyceride (LCT)50%-MCT50%) or FO containing PN (FO: Lipoplus: LCT40%-MCT50%-FO10%). Energy target were set at 1.3 times the preoperative resting energy expenditure by indirect calorimetry. Blood sampling on days 0, 2, 3 and 4. Glucose turnover by the 2 H 2 -glucose method. Muscle microdialysis. Clinical data: maximal daily T1, intensive care unit (ICU) and hospital stay. Results: Both solutions were clinically well tolerated, without any differences in laboratory safety parameters, inflammatory, metabolic data, or in organ failures. Plasma tocopherol increased similarly; with FO, docosahexaenoic and eicosapentaenoic acid increased significantly by day 4 versus baseline or STD. To increased postoperatively, with a trend to lower values in FO group (P ¼ 0.09). After FO, a trend toward shorter ICU stay (1.670.4 versus 2.370.4), and hospital stay (9.972.4 versus 11.372.7 days: P ¼ 0.19) was observed. Conclusions: Both lipid emulsions were well tolerated. FO-PN enhanced the plasma n-3 polyunsaturated fatty acid content, and was associated with trends to lower body temperature and shorter length of stay.

Parenteral Nutrition Enriched with Fish Oil after Gastrointestinal Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Eight studies reported this outcome [11,12,15,23,24,26,27,32]. The analysis showed a significant decrease in HLOS within the intervention group compared with the control group.…”

“…Figure 1 shows the process for identifying potentially eligible studies and exclusion criteria. After elaborative screening, 34 articles were assessed by full text and 17 studies with 753 patients [2,[10][11][12]15,16,[23][24][25][26][27][28][29][30][31][32][33] were included for the review. However, three publications [2,24,30,31,33] are same study that reported different outcomes.…”

“…FO favorably modulates lipid mediator patterns [10][11][12] and the inflammatory response in surgical patients [12,13], reducing the hospital stay [13][14][15] when compared with Long-Chain Triglycerides (LCT) or Long-Chain Triglycerides/Medium-Chain Triglycerides (LCT/MCT). However, there are studies demonstrating that administration of FO (0.2 g/kg per day) after surgical stress is not immunosuppressive, but increases production of IFN-γ, TNF-α, and IL-2 [16].…”

Nutrition and the Aorto-Iliac Atherosclerotic Disease

“…Use of 3 fatty acids as part of nutritional intervention in ESRV might also result in stabilization of the atherosclerotic plaque, thus facilitating the work of angiologist surgeon [39]. Morever, it has been reported that use of parenteral lipids solutions incorporating fish oil as a source of 3 fatty acids shortened hospital length of stay of patients electively subjected to abdominal aortic aneurysm surgery [40]. However, is should be remembered that prolonged use of 3 fatty acids might modify shape, size, distribution and lipid composition of HDL High density Lipoproteins that have been linked to a reduced risk of atherosclerotic damage [41].…”

Rationale for using new lipid emulsions in parenteral nutrition and a review of the trials performed in adults

“…In a recently published study that used MCT-soyabean oil or Lipoplus in patients in the ICU who had undergone abdominal aorta aneurysm repair surgery no differences were found in glucose metabolism or in inflammatory markers (52) . Furthermore, clinical outcomes were not reported to be affected, but a trend was found towards shorter ICU stay (1 .…”