Three short perioperative infusions of n-3 PUFAs reduce systemic inflammation induced by cardiopulmonary bypass surgery: a randomized controlled trial

Abstract

Background: Fish oil (FO) has antiinflammatory effects, which might reduce systemic inflammation induced by a cardiopulmonary bypass (CPB). Objective: We tested whether perioperative infusions of FO modify the cell membrane composition, inflammatory responses, and clinical course of patients undergoing elective coronary artery bypass surgery. Design: A prospective randomized controlled trial was conducted in cardiac surgery patients who received 3 infusions of 0.2 g/kg FO emulsion or saline (control) 12 and 2 h before and immediately after surgery. Blood samples (7 time points) and an atrial biopsy (during surgery) were obtained to assess the membrane incorporation of PUFAs. Hemodynamic data, catecholamine requirements, and core temperatures were recorded at 10-min intervals; blood triglycerides, nonesterified fatty acids, glucose, lactate, inflammatory cytokines, and carboxyhemoglobin concentrations were measured at selected time points. Results: Twenty-eight patients, with a mean 6 SD age of 65.5 6 9.9 y, were enrolled with no baseline differences between groups. Significant increases in platelet EPA (+0.86%; P = 0.0001) and DHA (+0.87%; P = 0.019) were observed after FO consumption compared with at baseline. Atrial tissue EPA concentrations were higher after FO than after control treatments (+0.5%; P , 0.0001). FO did not significantly alter core temperature but decreased the postoperative rise in IL-6 (P = 0.018). Plasma triglycerides increased transiently after each FO infusion. Plasma concentrations of glucose, lactate, and blood carboxyhemoglobin were lower in the FO than in the control group on the day after surgery. Arrhythmia incidence was low with no significant difference between groups. No adverse effect of FO was detected. Conclusions: Perioperative FO infusions significantly increased PUFA concentrations in platelet and atrial tissue membranes within 12 h of the first FO administration and decreased biological and clinical signs of inflammation. These results suggest that perioperative FO may be beneficial in elective cardiac surgery with CPB. This trial was registered at clinicaltrials.gov as NCT00516178.Am J Clin Nutr 2013;97:246-54.

Beneficial Effects of Enteral Docosahexaenoic Acid on the Markers of Inflammation and Clinical Outcomes of Neonates Undergoing Cardiovascular Surgery: An Intervention Study

“…Lower IL-1β production and plasma concentration has been reported in the n-3 LC-PUFAs group compared with a control group in surgical [13] and septic adults [14]. Likewise, the lower postoperative IL-6 observed in DHA group compared with SO group has been previously reported in surgical adults [16,17,25]. Poor clinical outcome was associated with high concentrations of IL-6 [26]; thus, DHA effects appear to be beneficial for neonates.…”

“…Perioperative administration of DHA and EPA with parenteral lipid emulsions has demonstrated beneficial effects on clinical outcomes in surgical adults [16,17] and in septic neonates who received DHA during an episode of sepsis [11]. However, neonates did not receive TPN if they had a functional gastrointestinal tract; thus, enteral administration of DHA may be an affordable and physiological intervention without TPN-related complications.…”

Preoperative Standard Oral Nutrition Supplements vs Immunonutrition: Results of a Systematic Review and Meta-Analysis

“…Omega-3 fatty acids in several perioperative randomized trials have been demonstrated to modulate proinflammatory and antiinflammatory mediators in the heart, gut, liver, and in tumor tissue. [31][32][33][34] Antioxidants are typically the other key ingredient in IN products. Preoperative antioxidants have been shown to increase serum and tissue antioxidant levels, but the clinical benefit is unclear.…”

Effects unrelated to anti-inflammation of lipid emulsions containing fish oil in parenteral nutrition for adult patients

“…The average glycemia during the first 24 hours after surgery was significantly lower in the FO group. However, insulin requirements and endogenous glucose production were similar in both groups in the first 24 hours (38).…”

“…In the second study, 23 patients were randomized to receive FO 100% 0.2 g/kg or saline administered two times on the evening before cardiopulmonary bypass and immediately before surgery. The FO group presented shorter ventilation time but no significant impact on the oxygenation index was observed (38).…”