Safety and metabolic tolerance of a concentrated long‐chain triglyceride lipid emulsion in critically ill septic and trauma patients

Garcı́a-de-Lorenzo, Abelardo; López‐Martínez, Jorge Omar; Planas, M.; Chacón, Pilar; Montejo, Juan Carlos; Bonet, Alfons; Ortíz-Leyba, Carlos; Sanchez-Segura, Juan M.; Ordóñez, J.; Acosta, José A.; Grau, T.; Jiménez, F. J. Jiménez

doi:10.1177/0148607103027003208

Cited by 23 publications

(15 citation statements)

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“…The overall benefits to critically ill patients of balanced nutrition, which includes lipid emulsions that are generally safe, outweighs these concerns [11].…”

Section: Lipid Metabolismmentioning

confidence: 99%

“…A better understanding of hepatic fatty acid metabolism is still needed [16]. The choice of medium-or long-chain triglycerides or a combination of the two is not well defined [11,17,18], though certain patient populations may benefit from mediumchain triglycerides [19,20]. Patients should receive a minimum of 4% to 8% of calories from lipid emulsion, which is typically 50% linoleic acid .…”

Section: Lipid Metabolismmentioning

confidence: 99%

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Metabolic and catheter complications of parenteral nutrition

Ghabril

Aranda-Michel

Scolapio

2004

Curr Gastroenterol Rep

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Since its introduction in the 1960s, total parenteral nutrition (TPN) has played a vital role in improving clinical outcomes for patients with acute and chronic illnesses. The evolution of TPN solutions and vascular access techniques, combined with an increased awareness and better understanding of the physiology of TPN, have improved the safety of this therapy. Nevertheless, complications are not uncommon and can be life threatening. This article provides an updated review on the metabolic and catheter complications associated with TPN.

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“…The overall benefits to critically ill patients of balanced nutrition, which includes lipid emulsions that are generally safe, outweighs these concerns [11].…”

Section: Lipid Metabolismmentioning

confidence: 99%

Section: Lipid Metabolismmentioning

confidence: 99%

Metabolic and catheter complications of parenteral nutrition

Ghabril

Aranda-Michel

Scolapio

2004

Curr Gastroenterol Rep

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“…Jones el al originally proposed the beneficial effects of the soybean-based ILE as a myocardial energy substrate after ischemic arrest (15) and Van de Velde et al demonstrated the benefit of a systemic-infusion of ILE during recovery in several animal models of cardiac stunning (16, 17). The use of ILE during resuscitation is advantageous from a practical standpoint since ILE are readily available, clinically approved (as a parenteral nutrition supplement), easily infused, and exhibits a favorable safety profiles (18–20). These clinical advantages have led to the use to ILE as an effective treatment for cardiac pharmacotoxicity (21, 22).…”

Section: Introductionmentioning

confidence: 99%

Lipid Emulsion Rapidly Restores Contractility in Stunned Mouse Cardiomyocytes

Li¹,

Fettiplace²,

Chen³

et al. 2014

Critical Care Medicine

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Objective Cooling following cardiac arrest can improve survival significantly. However, delays in achieving target temperature may decrease the overall benefits of cooling. Here we test whether lipid emulsion, a clinically approved drug reported to exert cardioprotection, can rescue heart contractility in the setting of delayed cooling in stunned mouse cardiomyocytes. Design Cell culture study Setting Academic research laboratory Subjects Cardiomyocytes isolated from 1–2-day old C57BL6 mice Interventions Cardiomyocytes were exposed to 30 minutes of ischemia followed by 90 minutes reperfusion and 10 minutes isoproterenol with nine interventions: 1) no additional treatment; 2) intra-ischemic cooling at 32°C initiated 10 min prior to reperfusion; 3) delayed cooling started 20 minutes after reperfusion; 4) lipid emulsion + delayed cooling; 5) lipid emulsion (0.25%) administered at reperfusion; 6) lipid emulsion + intra-ischemic cooling; 7) delayed lipid emulsion; 8) lipid emulsion + delayed cooling + Akt inhibitor (API-2, 10 μM) and 9) lipid emulsion + delayed cooling + Erk inhibitor (U0126, 10 μM). Inhibitors were given to cells 1 h prior to ischemia. Measurements and Main Results Contractility was recorded by real-time phase-contrast imaging and analyzed with pulse image velocimetry in MATLAB. Ischemia diminished cell contraction. The cardioprotective effect of cooling was diminished when delayed but was rescued by lipid emulsion. Further, lipid emulsion on its own improved recovery of the contractility to an equal extent as intra-ischemic cooling. However, co-treatment of lipid emulsion and intra-ischemic cooling did not further improve the recovery compared to either treatment alone. Moreover, Akt and Erk inhibitors blocked lipid emulsion-induced protection. Conclusion Lipid emulsion improved contractility and rescued contractility in the context of delayed cooling. This protective effect required Akt and Erk signaling. Lipid emulsion might serve as a treatment or adjunct to cooling in ameliorating myocardial ischemia/reperfusion injury.

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“…Practices used as precautionary methods for patients at risk of refeeding syndrome, such as replacing abnormal electrolytes, are supported by the literature (Solomon and Kirby, 1990;Crook et al, 2001). Different lipid emulsions based on different concentrations of triglyceride, fatty acids and phospholipid are available (Garcia de Lorenzo et al, 2003). A number of early studies suggested that high triglyceride emulsions suppress immunological function, thereby increasing patients' risk of infection and complications (Fischer et al, 1980;Fraser et al, 1983).…”

Section: Implementation Of Nutrition Care Planmentioning

confidence: 99%

“…A recent study found that lipid emulsions of high triglyceride concentration (30% intralipid) resulted in fewer disturbances in lipid metabolism in critically ill septic and trauma patients, compared to lipid emulsions of lower triglyceride concentration (20% intralipid) (Level II evidence) (Garcia de Lorenzo et al, 2003). The authors suggest that this may be due to the lower phospholipid/triglyceride ratio in the former emulsion, with both lipid emulsions showing similar results with respect to tolerance and safety (Garcia de Lorenzo et al, 2003).…”

Section: Implementation Of Nutrition Care Planmentioning

confidence: 99%

Current practices in the delivery of parenteral nutrition in Australia

2006

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Objective: To determine current practice in the delivery of parenteral nutrition (PN) in Australian hospitals. Design: A cross-sectional mail survey. Setting: Acute-care adult hospitals with greater than 200 beds in Australia. Subjects: A total of 67 hospitals (65.7% response rate). Intervention: Surveys were posted to hospitals. A reminder letter with a second copy of the survey was posted 3 weeks later to non-respondents. Results: Twenty-seven (40.3%) of the hospitals have a PN team and 50 (74.6%) have a hospital protocol for PN delivery. An inaccessible or non-functional gastrointestinal tract is the most common indicator for commencing PN. Fat infusion is calculated by 24 (38.7%) respondents with a mean (s.d.) maximum amount of fat provided of 2.0 (0.7) g/kg/day. Over half (n ¼ 35) reported calculating carbohydrate infusion at a maximum amount of 5.4 (1.0) mg/kg/min. Two-thirds (n ¼ 41) reported commencing PN at a rate of 50% or less of goal rate. Blood glucose levels (BGL) were monitored at least once per day by the majority of respondents (n ¼ 56, 83.6%). Insulin infusion was commenced at varying BGL. Most respondents (n ¼ 40, 59.7%) reported ceasing PN when at least half of the patient's requirements are being met either orally or enterally. A number of practice guidelines were identified and the results of the survey were compared with these guidelines. Conclusions: Where there are clear practice guidelines, current practice appears to be in line with these recommendations, however, where evidence is lacking, practice is varied.

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Safety and metabolic tolerance of a concentrated long‐chain triglyceride lipid emulsion in critically ill septic and trauma patients

Abstract: Our results indicate that while both fat emulsions used in the TPN of critically ill patients are clinically safe, the 30% long-chain triglyceride fat emulsion with a phospholipid/triglyceride ratio of 0.04 causes fewer lipid metabolic disturbances.

Cited by 23 publications

References 0 publications

Metabolic and catheter complications of parenteral nutrition

Metabolic and catheter complications of parenteral nutrition

Lipid Emulsion Rapidly Restores Contractility in Stunned Mouse Cardiomyocytes

Current practices in the delivery of parenteral nutrition in Australia

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