Is Omega-3 Fatty Acids Enriched Nutrition Support Safe for Critical Ill Patients? A Systematic Review and Meta-Analysis

Chen, Wei; Jiang, Hua; Zhou, Zhiyuan; Tao, Yexuan; Cai, Bin; Liu, Jie; Yang, Hao; Lu, Charles Damien; Zeng, Jun

doi:10.3390/nu6062148

Cited by 31 publications

(24 citation statements)

References 48 publications

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“…Most concerning are reported trends towards increased mortality [20, 28, 31, 39, 49]. Even in meta-analyses that demonstrate a non-significant reduction in mortality [18, 44, 50, 51], as this one does, the upper limit of the CI cannot exclude the potential for increased mortality with omega-3 supplementation. Detailed data on non-surviving patients would be necessary to explore characteristics associated with increased mortality risk with omega-3 supplementation.…”

Section: Discussionmentioning

confidence: 99%

Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials

Sharma

McIntyre

et al. 2017

Ann. Intensive Care

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BackgroundNutritional supplementation of omega-3 fatty acids has been proposed to modulate the balance of pro- and anti-inflammatory mediators in sepsis. If proved to improve clinical outcomes in critically ill patients with sepsis, this intervention would be easy to implement. However, the cumulative evidence from several randomized clinical trials (RCTs) remains unclear.MethodsWe searched the Cochrane Library, MEDLINE, and EMBASE through December 2016 for RCTs on parenteral or enteral omega-3 supplementation in adult critically ill patients diagnosed with sepsis or septic shock. We analysed the included studies for mortality, intensive care unit (ICU) length of stay, and duration of mechanical ventilation, and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the quality of the evidence for each outcome.ResultsA total of 17 RCTs enrolling 1239 patients met our inclusion criteria. Omega-3 supplementation compared to no supplementation or placebo had no significant effect on mortality [relative risk (RR) 0.85; 95% confidence interval (CI) 0.71, 1.03; P = 0.10; I 2 = 0%; moderate quality], but significantly reduced ICU length of stay [mean difference (MD) −3.79 days; 95% CI −5.49, −2.09; P < 0.0001, I 2 = 82%; very low quality] and duration of mechanical ventilation (MD −2.27 days; 95% CI −4.27, −0.27; P = 0.03, I 2 = 60%; very low quality). However, sensitivity analyses challenged the robustness of these results.ConclusionOmega-3 nutritional supplementation may reduce ICU length of stay and duration of mechanical ventilation without significantly affecting mortality, but the very low quality of overall evidence is insufficient to justify the routine use of omega-3 fatty acids in the management of sepsis.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0282-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials

Sharma

McIntyre

et al. 2017

Ann. Intensive Care

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“…This lack of effect of FO-enriched PN on mortality rate compared to standard PN is confirmed by 533 meta-analyses of 6 RCTs [124] and of 8 RCTs [125] in critically ill adults, the latter also finding 534 no difference in infectious complications or ICU length of stay. There was weak evidence of a 535 reduction of hospital length of stay associated with FO-enriched PN, but this was strongly 536 influenced by one small study [125].…”

Section: Fish Oil-containing Lipid Emulsions 396mentioning

confidence: 90%

Lipids in the intensive care unit: Recommendations from the ESPEN Expert Group

et al. 2018

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acid-rich vegetable oil-based enteral and parenteral nutrition is still widely used, newer lipid 53 components such as medium-chain triglycerides and olive oil are safe and well tolerated. Fish 54 oil (FO)-enriched enteral and parenteral nutrition appears to be well tolerated and confers 55 additional clinical benefits, particularly in surgical patients, due to its anti-inflammatory and 56immune-modulating effects. Whilst the evidence base is not conclusive, there appears to be a 57 potential for FO-enriched nutrition, particularly administered peri-operatively, to reduce the rate 58 of complications and intensive care unit (ICU) and hospital stay in surgical ICU patients. The 59 evidence for FO-enriched nutrition in non-surgical ICU patients is less clear regarding its clinical 60 benefits and additional, well-designed large-scale clinical trials need to be conducted in this 61 area. The ESPEN Expert Group supports the use of olive oil and FO in nutrition support in 62 surgical and non-surgical ICU patients but considers that further research is required to provide 63 a more robust evidence base. 64 65 Page 4 of 77 Nutrition support of the critically ill patient 66Patients in an intensive care unit (ICU) are heterogeneous and include surgical and medical 67 patients, mechanically-ventilated or non-ventilated, obese or undernourished, preterm infants to 68 older adults, requiring either short-term or long-term intensive care [1]. Nutrition support is 69 critical in maintaining homeostasis in the ICU patient and to provide nutrients for the 70 maintenance of lean body mass as well as repair and maintenance of organ function and 71 support of defense and healing processes. 72Enteral nutrition (EN) comprises specialized liquid nutrition delivered through a nasogastric or 73 post-pyloric feeding tube into the stomach or small intestine (duodenum/jejunum), respectively 74[2]. The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend 75 that EN should be given to all ICU patients who are not expected to be taking a full oral diet 76 within three days [3]. 77Whilst ESPEN acknowledges that there are no definitive data supporting the early use of EN in 78 terms of clinical outcomes, its guidelines recommend that hemodynamically stable critically ill 79 patients who have a functioning gastrointestinal tract should be fed early (< 24 hours) using an 80 appropriate amount of feed [3]. Early initiation of EN is also recommended by the American 81 Society for Parenteral and Enteral Nutrition (ASPEN) and the Canadian Society of Critical Care 82Medicine (SCCM) [4], as well as the European Society of Intensive Care Medicine (ESICM) [5]. 83Administration of early EN in critically ill patients appears to also have a positive economic 84 impact, with analysis suggesting that it is associated with significantly reduced costs relating to 85 reduction in ICU stay and duration of mechanical ventilation compared with standard care [6]. 86There are a number of nutritional and non-nutritional benefits associa...

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“…However, the use of IV FE in the USA is limited to soybean-based lipid emulsions while in Europe and other places in the world, olive oil and fish oilbased IVFE are of common use, increasing the safety of the administration. In two large meta-analysis [25,42], IV fish oilbased lipids were shown to improve length of stay and infection rate in both surgical and intensive care populations but did not influence mortality. Therefore, it is reasonable to recommend the use of these lipids when PN is recommended at the daily dose of 0.7 to 1.2 g/kg.…”

Section: Macronutrients Vitamins and Trace Elementsmentioning

confidence: 99%

Is Total Parenteral Nutrition (TPN) an Evil in Trauma Patients?

2016

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The use of parenteral nutrition has been progressively decreasing over the past 30 years, and it has been considered as harmful while enteral feeding has been preferred for critically ill trauma patients, including for head trauma patients. However, the use of enteral feeding is associated with underfeeding while the use of parenteral nutrition can create complications due to overfeeding (infections, increased length of stay, length of ventilation, increased liver tests). Measuring energy expenditure by indirect calorimetry enables more accurate energy needs and calorie targets can be optimized. Formulas with higher protein content allow increased protein administration. In case of gastrointestinal intolerance, parenteral nutrition is an efficient alternative route to reach optimal targets. This route may improve clinical outcome. The use of parenteral nutrition has recently been shown to be safe if not given in excess, challenging the theory that TPN should be avoided. A reevaluation of the use of parenteral nutrition has to be performed to decrease calorie and nitrogen deficits in critically ill trauma patients.

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Is Omega-3 Fatty Acids Enriched Nutrition Support Safe for Critical Ill Patients? A Systematic Review and Meta-Analysis

Cited by 31 publications

References 48 publications

Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials

Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials

Lipids in the intensive care unit: Recommendations from the ESPEN Expert Group

Is Total Parenteral Nutrition (TPN) an Evil in Trauma Patients?

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