Abstract
IntroductionThe 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.MethodsTwenty-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.ResultsFish 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.ConclusionsInclusion 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.Trials RegistrationClinical Trials Registration Number ISRCTN89432944
Highlights
The effect of parenteral fish oil in septic patients is not widely studied
Tappy et al [19] demonstrated that parenteral fish oil is well tolerated and has only limited metabolic effects in critically ill patients, while Antebi et al [20] showed that the use of fish oil in intensive care unit (ICU) patients requiring total parenteral nutrition may be associated with better liver function and improved antioxidant status
Friesecke et al [24] reported that use of a mixed a triglyceride rich in medium-chain fatty acids (MCT)/ soybean oil (LCT)/fish oil lipid emulsion in critically ill ICU patients had no effect on inflammatory markers, or on clinical outcomes including infections, ventilation requirement, or ICU or hospital stay compared with MCT/LCT
Summary
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. Mayer et al [21,22] reported diminished inflammation, including reduced TNF-α, IL-1β, IL-6, IL-8 and IL-10 production by cultured monocytes, in septic patients receiving a soybean oil-fish oil mix compared to those receiving soybean oil alone. These two studies did not report any clinical outcomes. Friesecke et al [24] reported that use of a mixed MCT/ LCT/fish oil lipid emulsion in critically ill ICU patients had no effect on inflammatory markers, or on clinical outcomes including infections, ventilation requirement, or ICU or hospital stay compared with MCT/LCT. Studies of enteral nutrition providing fish oil, in addition to other potentially active ingredients, have demonstrated reduced inflammation, improved gas exchange and improved clinical outcome in patients with acute respiratory distress syndrome and/or acute lung injury [26,27,28]
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