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Effects of a fish oil containing lipid emulsion on plasma phospholipid fatty acids, inflammatory markers, and clinical outcomes in septic patients: a randomized, controlled clinical trial

Effects of a fish oil containing lipid emulsion on plasma phospholipid fatty acids, inflammatory markers, and clinical outcomes in septic patients: a randomized, controlled clinical trial
Effects of a fish oil containing lipid emulsion on plasma phospholipid fatty acids, inflammatory markers, and clinical outcomes in septic patients: a randomized, controlled clinical trial
Introduction: the effect of parenteral fish oil in septic patients is not widely studied. This study investigated the effects of parenteral fish oil on plasma phospholipid fatty acids, inflammatory mediators, and clinical outcomes.
Methods: twenty-five patients with systemic inflammatory response syndrome or sepsis, and predicted to need parenteral nutrition were randomized to receive either a 50:50 mixture of medium-chain fatty acids and soybean oil or a 50:40:10 mixture of medium-chain fatty acids, soybean oil and fish oil. Parenteral nutrition was administrated continuously for five days from admission. Cytokines and eicosanoids were measured in plasma and in lipopolysaccharide-stimulated whole blood culture supernatants. Fatty acids were measured in plasma phosphatidylcholine.
Results: fish oil increased eicosapentaenoic acid in plasma phosphatidylcholine (P <0.001). Plasma interleukin (IL)-6 concentration decreased significantly more, and IL-10 significantly less, in the fish oil group (both P <0.001). At Day 6 the ratio PO2/FiO2 was significantly higher in the fish oil group (P = 0.047) and there were fewer patients with PO2/FiO2 <200 and <300 in the fish oil group (P = 0.001 and P = 0.015, respectively). Days of ventilation, length of intensive care unit (ICU) stay and mortality were not different between the two groups. The fish oil group tended to have a shorter length of hospital stay (22 ± 7 vs. 55 ± 16 days; P = 0.079) which became significant (28 ± 9 vs. 82 ± 19 days; P = 0.044) when only surviving patients were included.
Conclusions: inclusion of fish oil in parenteral nutrition provided to septic ICU patients increases plasma eicosapentaenoic acid, modifies inflammatory cytokine concentrations and improves gas exchange. These changes are associated with a tendency towards shorter length of hospital stay.
Clinical Trials Registration Number ISRCTN89432944
1364-8535
1-29
Barbosa, Vera M.
c38a0090-c38b-4536-9fa0-49a91469277f
Miles, Elizabeth A.
20332899-ecdb-4214-95bc-922dde36d416
Calhau, Conceiao
14b32eb6-9b16-4b10-9376-f68bb278ddc2
Lafuente, Estevao
b4d7f3f1-08e5-4b5c-9003-533de79ade30
Calder, Phillip C.
1797e54f-378e-4dcb-80a4-3e30018f07a6
Barbosa, Vera M.
c38a0090-c38b-4536-9fa0-49a91469277f
Miles, Elizabeth A.
20332899-ecdb-4214-95bc-922dde36d416
Calhau, Conceiao
14b32eb6-9b16-4b10-9376-f68bb278ddc2
Lafuente, Estevao
b4d7f3f1-08e5-4b5c-9003-533de79ade30
Calder, Phillip C.
1797e54f-378e-4dcb-80a4-3e30018f07a6

Barbosa, Vera M., Miles, Elizabeth A., Calhau, Conceiao, Lafuente, Estevao and Calder, Phillip C. (2010) Effects of a fish oil containing lipid emulsion on plasma phospholipid fatty acids, inflammatory markers, and clinical outcomes in septic patients: a randomized, controlled clinical trial. Critical Care, 14 (1), 1-29. (doi:10.1186/cc8844).

Record type: Article

Abstract

Introduction: the effect of parenteral fish oil in septic patients is not widely studied. This study investigated the effects of parenteral fish oil on plasma phospholipid fatty acids, inflammatory mediators, and clinical outcomes.
Methods: twenty-five patients with systemic inflammatory response syndrome or sepsis, and predicted to need parenteral nutrition were randomized to receive either a 50:50 mixture of medium-chain fatty acids and soybean oil or a 50:40:10 mixture of medium-chain fatty acids, soybean oil and fish oil. Parenteral nutrition was administrated continuously for five days from admission. Cytokines and eicosanoids were measured in plasma and in lipopolysaccharide-stimulated whole blood culture supernatants. Fatty acids were measured in plasma phosphatidylcholine.
Results: fish oil increased eicosapentaenoic acid in plasma phosphatidylcholine (P <0.001). Plasma interleukin (IL)-6 concentration decreased significantly more, and IL-10 significantly less, in the fish oil group (both P <0.001). At Day 6 the ratio PO2/FiO2 was significantly higher in the fish oil group (P = 0.047) and there were fewer patients with PO2/FiO2 <200 and <300 in the fish oil group (P = 0.001 and P = 0.015, respectively). Days of ventilation, length of intensive care unit (ICU) stay and mortality were not different between the two groups. The fish oil group tended to have a shorter length of hospital stay (22 ± 7 vs. 55 ± 16 days; P = 0.079) which became significant (28 ± 9 vs. 82 ± 19 days; P = 0.044) when only surviving patients were included.
Conclusions: inclusion of fish oil in parenteral nutrition provided to septic ICU patients increases plasma eicosapentaenoic acid, modifies inflammatory cytokine concentrations and improves gas exchange. These changes are associated with a tendency towards shorter length of hospital stay.
Clinical Trials Registration Number ISRCTN89432944

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Submitted date: 6 July 2009
Published date: 19 January 2010
Organisations: Dev Origins of Health & Disease

Identifiers

Local EPrints ID: 72440
URI: http://eprints.soton.ac.uk/id/eprint/72440
ISSN: 1364-8535
PURE UUID: 5035d8b1-fcf8-4e80-a0d8-d2bf7d9bee3d
ORCID for Elizabeth A. Miles: ORCID iD orcid.org/0000-0002-8643-0655

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Date deposited: 15 Feb 2010
Last modified: 07 Oct 2020 03:09

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