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Immunonutrition for adults with ARDS: Results from a cochrane systematic review and meta-analysis

Immunonutrition for adults with ARDS: Results from a cochrane systematic review and meta-analysis
Immunonutrition for adults with ARDS: Results from a cochrane systematic review and meta-analysis

BACKGROUND: ARDS is an overwhelming systemic inflammatory process associated with significant morbidity and mortality. Several trials have evaluated the effects of pharmaconutrients, given as part of a feeding formula or as a nutritional supplement, on clinical outcomes in critical illness and ARDS. The aim of this review is to assess the effects of immunonutrition on mechanically ventilated adults with ARDS compared to the standard feeding formula. METHODS: We searched MEDLINE, EMBASE, CENTRAL, conference proceedings, and trial registries for appropriate studies up to April 2018. We performed statistical analysis according to Cochrane methodological standards. We used the GRADE approach to assess the quality of evidence for each outcome. RESULTS: We identified 10 randomized controlled trials with 1,015 participants. All of the studies compared an enteral formula or additional supplemental omega-3 fatty acids (eg, eicosapentaenoic acid, docosahexaenoic acid), γ-linolenic acid, and antioxidants. All of the studies reported mortality. For the primary outcome, there was no difference in all-cause mortality (for the longest period reported) with the use of an immunonutrition enteral formula or additional supplements of omega-3 fatty acids, γ-linolenic acid, and antioxidants (risk ratio = 0.79, 95% CI 0.59 –1.07; low-quality evidence). For the secondary outcomes, we are uncertain whether immunonutrition with omega-3 fatty acids and antioxidants improves ICU length of stay, ventilator days, and oxygenation or increases harm. CONCLUSIONS: This Cochrane meta-analysis of 10 studies of varying quality examined the effects of omega-3 fatty acids and antioxidants in adults with ARDS. This intervention may produce little or no difference in all-cause mortality between groups. We are uncertain whether immunonutrition with omega-3 fatty acids and antioxidants improves ventilator days, ICU length of stay, or oxygenation due to the very low quality of evidence.

Acute respiratory distress syndrome, Immunonutrition, Omega-3 fatty acids
0020-1324
99-110
Dushianthan, Ahilanandan
013692a2-cf26-4278-80bd-9d8fcdb17751
Cusack, Rebecca
dfb1595f-2792-4f76-ac6d-da027cf40146
Burgess, Victoria A.
c17a8d37-6844-4169-b667-48cf71738bf4
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Calder, Philip
1797e54f-378e-4dcb-80a4-3e30018f07a6
Dushianthan, Ahilanandan
013692a2-cf26-4278-80bd-9d8fcdb17751
Cusack, Rebecca
dfb1595f-2792-4f76-ac6d-da027cf40146
Burgess, Victoria A.
c17a8d37-6844-4169-b667-48cf71738bf4
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Calder, Philip
1797e54f-378e-4dcb-80a4-3e30018f07a6

Dushianthan, Ahilanandan, Cusack, Rebecca, Burgess, Victoria A., Grocott, Michael P.W. and Calder, Philip (2020) Immunonutrition for adults with ARDS: Results from a cochrane systematic review and meta-analysis. Respiratory Care, 65 (1), 99-110. (doi:10.4187/respcare.06965).

Record type: Review

Abstract

BACKGROUND: ARDS is an overwhelming systemic inflammatory process associated with significant morbidity and mortality. Several trials have evaluated the effects of pharmaconutrients, given as part of a feeding formula or as a nutritional supplement, on clinical outcomes in critical illness and ARDS. The aim of this review is to assess the effects of immunonutrition on mechanically ventilated adults with ARDS compared to the standard feeding formula. METHODS: We searched MEDLINE, EMBASE, CENTRAL, conference proceedings, and trial registries for appropriate studies up to April 2018. We performed statistical analysis according to Cochrane methodological standards. We used the GRADE approach to assess the quality of evidence for each outcome. RESULTS: We identified 10 randomized controlled trials with 1,015 participants. All of the studies compared an enteral formula or additional supplemental omega-3 fatty acids (eg, eicosapentaenoic acid, docosahexaenoic acid), γ-linolenic acid, and antioxidants. All of the studies reported mortality. For the primary outcome, there was no difference in all-cause mortality (for the longest period reported) with the use of an immunonutrition enteral formula or additional supplements of omega-3 fatty acids, γ-linolenic acid, and antioxidants (risk ratio = 0.79, 95% CI 0.59 –1.07; low-quality evidence). For the secondary outcomes, we are uncertain whether immunonutrition with omega-3 fatty acids and antioxidants improves ICU length of stay, ventilator days, and oxygenation or increases harm. CONCLUSIONS: This Cochrane meta-analysis of 10 studies of varying quality examined the effects of omega-3 fatty acids and antioxidants in adults with ARDS. This intervention may produce little or no difference in all-cause mortality between groups. We are uncertain whether immunonutrition with omega-3 fatty acids and antioxidants improves ventilator days, ICU length of stay, or oxygenation due to the very low quality of evidence.

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RC-06965_submission May 2019 - Accepted Manuscript
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More information

Accepted/In Press date: 10 September 2019
e-pub ahead of print date: 27 December 2019
Published date: 1 January 2020
Keywords: Acute respiratory distress syndrome, Immunonutrition, Omega-3 fatty acids

Identifiers

Local EPrints ID: 441792
URI: http://eprints.soton.ac.uk/id/eprint/441792
ISSN: 0020-1324
PURE UUID: 27da5d99-7599-453f-868e-f3c0288dd362
ORCID for Ahilanandan Dushianthan: ORCID iD orcid.org/0000-0002-0165-3359
ORCID for Michael P.W. Grocott: ORCID iD orcid.org/0000-0002-9484-7581
ORCID for Philip Calder: ORCID iD orcid.org/0000-0002-6038-710X

Catalogue record

Date deposited: 26 Jun 2020 16:45
Last modified: 26 Nov 2021 03:15

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Contributors

Author: Ahilanandan Dushianthan ORCID iD
Author: Rebecca Cusack
Author: Victoria A. Burgess
Author: Philip Calder ORCID iD

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