Intravenous fish oil lipid emulsions in critically ill patients: an updated systematic review and meta-analysis

Abstract

IntroductionIntravenous fish oil (FO) lipid emulsions (LEs) are rich in ω-3 polyunsaturated fatty acids, which exhibit anti-inflammatory and immunomodulatory effects. We previously demonstrated that FO-containing LEs may be able to decrease mortality and ventilation days in patients who are critically ill. Since 2014, several additional randomized controlled trials (RCTs) of FO-containing LEs have been published. Therefore, the purpose of this systematic review was to update our previous systematic review with the aim of elucidating the efficacy of FO-containing LEs on clinical outcomes of patients who are critically ill.MethodsWe searched electronic databases from 1980 to 2014. We included four new RCTs conducted in critically ill adult patients in which researchers evaluated FO-containing LEs in parenterally or enterally fed patients.ResultsA total of 10 RCTs (n = 733) met inclusion criteria. The mean methodological score was 8 (range, 3 to 12). No effect on overall mortality was found. When we aggregated the results of five RCTs in which infections were reported, we found that FO-containing LEs significantly reduced infections (risk ratio (RR) = 0.64; 95% confidence interval (CI), 0.44 to 0.92; P = 0.02; heterogeneity I2 = 0%). Subgroup analysis demonstrated that predominantly enteral nutrition–based trials showed a tendency toward a reduction in mortality (RR = 0.69; 95% CI, 0.40 to 1.18; P =0.18; heterogeneity I2 =35%). High-quality trials showed a significant reduction in hospital length of stay (LOS) (weighted mean difference = −7.42; 95% CI, −11.89 to −2.94; P = 0.001), whereas low-quality trials had no effect (P = 0.45). The results of the test for subgroup differences in hospital LOS was significant (P = 0.001).ConclusionFO-containing LEs may be associated with a reduction in infections and also could be associated with a reduction in duration of ventilation and hospital LOS. Further large-scale RCTs are warranted and should be aimed at consolidating potential positive treatment effects.

Nuestros grandes olvidados, los enfermos respiratorios crónicos

“…Sin embargo, estudios en NP donde se utilizan emulsiones lipídicas enriquecidas con omega-3 provenientes del aceite de pescado (53,54), señalan una disminución en el número de infecciones nosocomiales, un incremento de los días libres de infección en pacientes médicos y quirúrgicos, con una menor duración de la VM y de la estancia hospitalaria, siendo, además, un tratamiento coste-efectivo (55). Estas emulsiones se consideran seguras y no se han reportado efectos adversos significativos e incluso han mejorado o revertido la toxicidad hepática de la NP (56).…”

“…Estas emulsiones se consideran seguras y no se han reportado efectos adversos significativos e incluso han mejorado o revertido la toxicidad hepática de la NP (56). En consecuencia, parece lógico recomendar NP enriquecida con omega-3 en pacientes críticos con SDRA que precisan NP (54).…”

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

“…In 2015, the same group of researchers, after analyzing data from 10 RCTs involving 733 patients, was not able to find any survival benefit from parenteral fish oil feeding in septic patients [50]. Nevertheless, a reduction in the incidence of infections and a trend toward reduced duration of mechanical ventilation and length of stay in ICU were reported.…”

“…Furthermore, intravenous fish oil feeding exhibited a nonsignificant trend toward reduced mortality. Since conflicting data have been originated from other systematic reviews and meta-analyses [51,52] "low sample size and heterogeneity of the cohorts included do not permit a final recommendation on the use of ω-3 PUFAs as a pharmaconutrient strategy in septic ICU patients" [50].…”

“…Furthermore and according to ASPEN Guidelines, current evidence does not support the use of enteral fish oil administration, particularly in medical ICU patients, due to heterogeneity of studies, variety of experimental and commercial lipid formulations, variable dosage of individual components, and increased costs [55]. Finally, two recent meta-analyses showed that the effect of fish oil lipid emulsions on mortality in septic patients was not influenced by the route of administration (enteral vs. parenteral) [50,61].…”