Parenteral Nutrition and Infection Risk in the Intensive Care Unit

McCleary, Emily; Tajchman, Sharla

doi:10.1177/0884533616653808

Cited by 19 publications

(13 citation statements)

References 72 publications

(168 reference statements)

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“…Omega-3 fatty acids can be applied through enteral and parenteral routes. Recently, PN has been shown to be insufficient in improving the prognosis of critically ill patients [ 40 ]. A study including infant patients observed that the application of soybean oil PN would induce a high risk of essential fatty acid deficiency [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Correlation analysis of omega-3 fatty acids and mortality of sepsis and sepsis-induced ARDS in adults: data from previous randomized controlled trials

Chen

Wang

Zhao

et al. 2018

Nutr J

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ObjectiveThis study aimed to investigate the possible effect of omega-3 fatty acids on reducing the mortality of sepsis and sepsis-induced acute respiratory distress syndrome (ARDS) in adults.MethodsMedline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI) database, WangFang database, and Chinese BioMedical Literature Database from their inception to March 6, 2017, were searched using systematic review researching methods. Five factors were analyzed to investigate the correlation between omega-3 fatty acids (either parenteral or enteral supplementation) and mortality rate.ResultsForty randomized controlled trials (RCTs) were initially included, but only 25 of them assessed mortality. Of these RCTs, nine used enteral nutrition (EN) and 16 used parenteral nutrition (PN). The total mortality rate in the omega-3 fatty acid group was lower than that in the control group. However, the odds ratio (OR) value was not significantly different in the EN or PN subgroup. Eighteen RCTs including 1790 patients with similar severity of sepsis and ARDS were also analyzed. The OR value was not significantly different in the EN or PN subgroup. Omega-3 fatty acids did not show positive effect on improving mortality of sepsis-induced ARDS (p = 0.39). But in EN subgroup, omega-3 fatty acids treatment seemed to have some benefits in reducing mortality rate (p = 0.04). In the RCTs including similar baseline patients, partial correlation analysis found that the concentration ratio of n-6 to n-3 fatty acids had positive correlation with reduction of mortality (RM) (γ = 0.60, P = 0.02), whereas the total number of each RCT had negative correlation with RM (γ = − 0.54, P = 0.05).ConclusionsThis review found that omega-3 fatty acid supplementation could reduce the mortality rate of sepsis and sepsis-induced ARDS. However, further investigation based on suitable concentrations and indications is needed to support the findings.

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Section: Discussionmentioning

confidence: 99%

Correlation analysis of omega-3 fatty acids and mortality of sepsis and sepsis-induced ARDS in adults: data from previous randomized controlled trials

Chen

Wang

Zhao

et al. 2018

Nutr J

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“…The result is a decreased ability of Kupffer cells to free hepatic toxins, including harmful microorganisms. Finally, IV lipids may interfere with macrophage and neutrophil function [41,42]. The clinical data regarding novel IVLEs and infectious outcomes are limited and mixed.…”

Section: Parenteral Nutrition Associated Liver Diseasementioning

confidence: 99%

Parenteral Nutrition and Lipids

et al. 2017

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Lipids have multiple physiological roles that are biologically vital. Soybean oil lipid emulsions have been the mainstay of parenteral nutrition lipid formulations for decades in North America. Utilizing intravenous lipid emulsions in parenteral nutrition has minimized the dependence on dextrose as a major source of nonprotein calories and prevents the clinical consequences of essential fatty acid deficiency. Emerging literature has indicated that there are benefits to utilizing alternative lipids such as olive/soy-based formulations, and combination lipids such as soy/MCT/olive/fish oil, compared with soybean based lipids, as they have less inflammatory properties, are immune modulating, have higher antioxidant content, decrease risk of cholestasis, and improve clinical outcomes in certain subgroups of patients. The objective of this article is to review the history of IVLE, their composition, the different generations of widely available IVLE, the variables to consider when selecting lipids, and the complications of IVLE and how to minimize them.

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“…As a result, a large macronutrient deficit often accumulates with time in ICU. The degree of such a macronutrient deficit has been associated with risk of infections and other complications [74]. This has been the basis for European practice guidelines to advocate the use of early parenteral nutrition [75].…”

Section: The Benefit Of Accepting Low Macronutrient Intake Early During Illnessmentioning

confidence: 99%

Glucose homeostasis, nutrition and infections during critical illness

Ingels

Vanhorebeek

Berghe

2018

Clinical Microbiology and Infection

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Critical illness is a complex life-threatening disease characterized by profound endocrine and metabolic alterations and by a dysregulated immune response, together contributing to the susceptibility for nosocomial infections and sepsis. Hitherto, two metabolic strategies have been shown to reduce nosocomial infections in the critically ill, namely tight blood glucose control and early macronutrient restriction. Hyperglycaemia, as part of the endocrine-metabolic responses to stress, is present in virtually all critically ill patients and is associated with poor outcome. Maintaining normoglycaemia with intensive insulin therapy has been shown to reduce morbidity and mortality, by prevention of vital organ dysfunction and prevention of new severe infections. The favourable effects of this intervention were attributed to the avoidance of glucose toxicity and mitochondrial damage in cells of vital organs and in immune cells. Hyperglycaemia was shown to impair macrophage phagocytosis and oxidative burst capacity, which could be restored by targeting normoglycaemia. An anti-inflammatory effect of insulin may have contributed to prevention of collateral damage to host tissues. Not using parenteral nutrition during the first week in intensive care units, and so accepting a large macronutrient deficit, also resulted in fewer secondary infections, less weakness and accelerated recovery. This was at least partially explained by a suppressive effect of early parenteral nutrition on autophagic processes, which may have jeopardized crucial antimicrobial defences and cell damage removal. The beneficial impact of these two metabolic strategies has opened a new field of research that will allow us to improve the understanding of the determinants of nosocomial infections, sepsis and organ failure in the critically ill.

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Parenteral Nutrition and Infection Risk in the Intensive Care Unit

Cited by 19 publications

References 72 publications

Correlation analysis of omega-3 fatty acids and mortality of sepsis and sepsis-induced ARDS in adults: data from previous randomized controlled trials

Correlation analysis of omega-3 fatty acids and mortality of sepsis and sepsis-induced ARDS in adults: data from previous randomized controlled trials

Parenteral Nutrition and Lipids

Glucose homeostasis, nutrition and infections during critical illness

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