The Effects of Different IV Fat Emulsions on Clinical Outcomes in Critically Ill Patients*

Edmunds, Christina; Brody, Rebecca; Parrott, J. Scott; Stankorb, Susan M.; Heyland, Daren K.

doi:10.1097/ccm.0000000000000146

Cited by 48 publications

(49 citation statements)

References 41 publications

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“…I n this issue of Critical Care Medicine, Edmunds et al ( 1 ) present interesting new data supporting the use of lipid emulsions rich in either olive oil (00) or fish oil as a component of total parenterai nutrition in critically ill patients.…”

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confidence: 97%

“…Each ICU enrolled about 20 patients who were admitted to the ICU for at least 72 hours and who were started on mechanical ventilation within 48 hours of admission. Edmunds et al ( 1 ) included patients who received parenterai nutrition for at least 5 days without prior or concurrent enterai nutrition. Patients had to receive a known type of lipid emulsion and to have no change in the lipid emulsion received.…”

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confidence: 99%

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Fishing for Improved Outcomes in the Critically Ill*

Calder

2014

Critical Care Medicine

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confidence: 97%

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Fishing for Improved Outcomes in the Critically Ill*

Calder

2014

Critical Care Medicine

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“…If these are soybean-based emulsions, this may explain the excess mortality. 6 It may be useful to report the rates of overfeeding per group and the amount of calories from parenteral and enteral sources rather than just combined. We think it is also important to separate the INMT intervention into its 2 phases: in the intensive care unit (ICU) and following extubation or post-ICU discharge.…”

Section: Letters To the Editormentioning

confidence: 99%

More Questions Than Answers

Heyland¹,

Dhaliwal²,

Lemieux³

2015

J Parenter Enteral Nutr

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We urge caution in overinterpreting the randomized trial by Braunschweig et al 1 published in the Journal of Parenteral and Enteral Nutrition. From a single center, a total of 78 patients were randomized to an intensive medical nutrition therapy (IMNT) designed to provide patients >75% of their estimated energy and protein requirements compared with standard care. At the first interim analysis, the investigators observed a statistically significant increase in mortality in the INMT group compared with standard nutrition care (40% vs 16%, P = .02). Randomized trials that are terminated prematurely are likely to significantly overestimate the treatment effect. 2 Moreover, a small study from 1 center has limited generalizability and should not inform practice patterns worldwide. In our opinion, to draw the conclusion that "provision of IMNT to hospital discharge increases mortality" seems premature. Nevertheless, the results cannot be ignored, and further questions about this trial are warranted.We note that with very broad inclusion criteria (patients aged ≥18 years with acute lung injury), there was no intention to enroll nutritionally "at-risk" patients 3 and that most were normo-nourished, with a body mass index that is shown to be insensitive to the provision of macronutrients. 4 When trying to understand the results of this trial, we think it is important to separate the nutrition intervention into its components. Patients were moderately dosed with protein and received only approximately 82 g/d or <1 g/kg/d-it is implausible that such protein doses are associated with harm, especially given recent recommendations for doses around 2-2.5 g/kg/d. 5 Patients were targeted to receive 30 kcal/kg and received approximately 85% of their prescriptions. From examination of Figure 2, it appears that some patients received more than 100% of their prescription, which is already high since most guidelines recommend 20-25 kcal/kg/d. Moreover, we note that patients in the IMNT group received more parenteral nutrition (PN) and significantly more parenteral lipids. If these are soybean-based emulsions, this may explain the excess mortality. 6 It may be useful to report the rates of overfeeding per group and the amount of calories from parenteral and enteral sources rather than just combined. We think it is also important to separate the INMT intervention into its 2 phases: in the intensive care unit (ICU) and following extubation or post-ICU discharge. Can the investigators report the % calorie and protein received in these 2 phases separately? As the investigators note, the increased mortality was due to early deaths or an early separation in the survival curves. It is difficult to fathom how optimal nutrition intake in the post-ICU phase of this study caused an early separation of the survival curves.Our main concern is that this study may represent overfeeding with parenteral calories in a normo-nourished or low-nutrition risk patient population in the early phase of critical illness. We acknowledge this may not be a benefi...

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“…The effects of different IV fat emulsions on clinical outcomes in critically ill patients. 24 Although a majority consensus could not be achieved, current clinical practice guidelines in the United States recommend withholding soybean oil (SO)-based lipid emulsion (LE) during the first week following initiation of PN in the ICU in non-malnourished patients and minimizing to 100 g/week in malnourished patients to prevent essential fatty acid deficiency. 7 The guidelines also suggest considering the use of alternative LEs (SMOF [SO, medium chain triglycerides (MCT), olive oil (OO), and fish oil (FO)], MCT, OO, and FO) in this patient population if available.…”

Section: Van Zanten Et Al (2014) High-protein Enteralmentioning

confidence: 99%

“…8. Edmunds et al (2014). The effects of different IV fat emulsions on clinical outcomes in critically ill patients.…”

Section: Van Zanten Et Al (2014) High-protein Enteralmentioning

confidence: 99%

Significant Published Articles for Pharmacy Nutrition Support Practice in 2014 and 2015

et al. 2016

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Purpose:To assist the pharmacy clinician engaged in nutrition support in staying current with the most pertinent literature. Methods: Several experienced board-certified clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2014 and 2015 that they considered to be important to their practice. Only those articles available in print format were considered for potential inclusion. Articles available only in preprint electronic format were not evaluated. The citation list was compiled into a single spreadsheet where the author participants were asked to ascertain whether they considered the paper important to nutrition support pharmacy practice. A culled list of publications was then identified whereby the majority of author participants (at least 5 out of 8) considered the paper to be important. Results: A total of 108 articles were identified; 36 of which were considered to be of high importance. An important guideline article published in early 2016, but not ranked, was also included. The top-ranked articles from the primary literature were reviewed. Conclusion: It is recommended that the informed pharmacist, who is engaged in nutrition support therapy, be familiar with the majority of these articles. 2016;51:539-552 S taying current with the literature is a requirement for the informed pharmacist who maintains an evidence-based clinical practice. This requirement has become more challenging to fulfill as a paradigm shift has changed the practice culture of a full-time pharmacy nutrition support specialist to a more integrated model whereby the clinical pharmacist provides pharmacotherapy services along with nutrition support responsibilities. As a result of this change, informed clinicians are responsible for staying abreast of numerous therapeutic areas that interface with their clinical practice in addition to nutrition support therapy. Because nutrition support therapy is integrated with many divergent specialized fields (eg, Key Words-consensus, enteral nutrition, guidelines, outcomes, parenteral nutrition Hosp Pharm

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The Effects of Different IV Fat Emulsions on Clinical Outcomes in Critically Ill Patients*

Abstract: Use of alternative IV fat emulsions in parenteral nutrition, particularly olive and fish oil, was associated with improved clinical outcomes.

Cited by 48 publications

References 41 publications

Fishing for Improved Outcomes in the Critically Ill*

Fishing for Improved Outcomes in the Critically Ill*

More Questions Than Answers

Significant Published Articles for Pharmacy Nutrition Support Practice in 2014 and 2015

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