To investigate the effect of a fish oil containing parenteral lipid emulsion on inflammatory markers, gas exchange and clinical outcomes in septic patients

[摘要] ENGLISH SUMMARY : Introduction: The effects of intravenous lipid emulsions containing fish oil in critically ill patients have not been studied widely and show conflicting results. This study compared the effects of a 4-oil lipid emulsion (SMOFlipid®) with a 100% soybean-based lipid emulsion in terms of biochemical parameters, inflammatory mediators, plasma total phospholipid fatty acid (FA) composition, sequential organ failure assessment (SOFA) score, gas exchange and clinical outcomes in patients with the systemic inflammatory response syndrome (SIRS) with or without sepsis.Design: Double blind, randomised, single-centre study.Method: Seventy-five patients predicted to need parenteral nutrition (PN) for ≥ five days were randomised to receive either a 4-oil lipid emulsion (Study Group (SG)) or a 100% soybean lipid emulsion (Control Group (CG)). Isocaloric, isonitrogenous PN was administered continuously. Routine biochemical measurements and gas exchange were assessed. SOFA score was calculated and plasma cytokines and total phospholipid FA composition was analysed.Results: Both groups were well matched for baseline characteristics, but the SG had a trend to a higher mean APACHE II score (13.7 ± 7.5 versus 11.2 ± 8.1, p=0.19). The nutritional intakes did not differ, except the SG received fish oil (FO), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and increased amounts of α-tocopherol and reduced amounts of phytosterols. Triglycerides and Gamma-glutamyl transferase (GGT) levels increased in both groups. Bilirubin levels decreased in both groups between day 1 and 3 and then continued to decrease in the SG, but increased significantly in the CG after day 3. Concentrations of TNF-α decreased from day 1 to day 6 in the SG, whereas they increased in the CG, but the difference was not significant. Concentrations of interleukin-1β (IL-1β) and IL-6 decreased in the SG during the intervention and increased in the CG after day 3; however the difference was not significant at day 6. IL-10 concentrations decreased in both groups between day 1 and day 3, but increased from day 3 to day 6 in the SG. This difference was not significant (p=0.972). Multiple positive changes in plasma total phospholipid FA percentages were demonstrated. Plasma EPA showed a significant increase in the SG (p<0.001). The n-6 polyunsaturated fatty acid (PUFA):n-3 PUFA ratio decreased in the SG and remained fairly constant in the CG. A significant correlation was found for day 3 EPA intake and improvement in SOFA score. Days on mechanical ventilation and ICU LOS were not different between the two groups.Conclusion: The results of this study suggest that PN containing a 4-oil LE with FO at a dose of 0.09 – 0.22g/kg in patients with SIRS, with or without sepsis, was associated with multiple changes in the plasma total phospholipid FA composition and a tendency to reduce plasma TNF-α and liver enzymes. There was no significant difference in terms of SOFA score, length of ICU stay and mortality. Additional studies need to be done in this patient population paying particular attention to the dose, duration and timing of FO and EPA per day and their effect on clinical outcomes.

[发布机构] Stellenbosch University