Immunonutrition for acute respiratory distress syndrome (ARDS) in adults

Abstract

Background: acute respiratory distress syndrome (ARDS) is a life-threatening condition wherein the lungs are inflamed (irritated) and damaged. In this state, the lungs cannot deliver into the blood enough oxygen for the body’s vital organs. It is usually seen in patients who are already seriously ill. Currently, no specific effective therapeutic options are available for this condition. Alternatively, change in dietary intake has been deployed. Modification of the nutrition given to adults with ARDS, to include components of food that have an anti-inflammatory effect, could reduce lung inflammation and improve outcomes in adults with this condition. Omega-3 fatty acids (known as DHA and EPA) are found in fish oils and can have an anti-inflammatory effect. Reviewers examined reported outcomes and effects of changes in nutrition among studies involving adults with ARDS.

Study characteristics: the evidence is current up to April 2018. We included in this review 10 studies with 1015 adult participants. These studies were conducted in intensive care units and compared standard nutrition (the usual nutrition given to patients with ARDS) versus nutrition supplemented with omega-3 fatty acids or placebo (a substance with no active effect), and compared either with or without antioxidants. Antioxidants are molecules that can inhibit or slow down oxidation - a reaction that can cause inflammation and damage cells.

Key results: it is unclear whether use of omega-3 fatty acids and antioxidants as part of nutritional intake in patients with ARDS improves long-term survival. It is uncertain whether omega-3 fatty acids and antioxidants reduce length of ICU stay and the number of days spent on a ventilator, or if they improve oxygenation. It is also unclear if this type of nutrition causes increased harm.

Quality of evidence: findings of this review are limited by lack of standardization among the included studies in terms of methods, types of nutritional supplements given, and reporting of outcome measures. We rated the quality of evidence as low to very low.

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Identifiers

ORCID for A. Dushianthan: orcid.org/0000-0002-0165-3359

ORCID for Michael Grocott: orcid.org/0000-0002-9484-7581

ORCID for Philip Calder: orcid.org/0000-0002-6038-710X

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