Abstract
IntroductionAcute respiratory distress syndrome (ARDS) is a major cause of mortality in intensive care units. Patients with ARDS often require parenteral nutrition with lipid emulsions as essential components. Besides being an energy supply, these lipid emulsions might display differential modulatory effects on lung integrity and inflammation.MethodsIn a pre-emptive strategy, we investigated the impact of three different intravenously infused lipid emulsions on lung morphology, leukocyte invasion, protein leakage and cytokines in a murine model of ARDS. Mice received an infusion of normal saline solution, a pure long-chain triglycerides (LCT) emulsion, a medium-chain triglycerides (MCT) containing mixed emulsion (LCT/MCT), or a fish oil (FO) containing mixed emulsion (LCT/MCT/FO) before lipopolysaccharide (LPS) challenge.ResultsMice pre-infused with fish oil-containing lipid emulsion showed decreased leukocyte invasion, protein leakage, myeloperoxidase activity, and cytokine production in their alveolar space after LPS challenge compared to mice receiving LCT or LCT/MCT. In line with these findings, lung morphology assessed by histological staining after LPS-induced lung injury improved faster in the LCT/MCT/FO group. Concerning the above mentioned parameters, no significant difference was observed between mice infused with LCT or the combination of LCT and MCT.ConclusionFish oil-containing lipid emulsions might exert anti-inflammatory and pro-resolving effects in the murine model of acute lung injury. Partial replacement of n-6 fatty acids with n-3 fatty acids may thus be of benefit for critically ill patients at risk for ARDS which require parenteral nutrition.
Highlights
Acute respiratory distress syndrome (ARDS) is a major cause of mortality in intensive care units
For a long time supplementation of fatty acids was exclusively relying on soybean or safflower oil-based long-chain triglycerides (LCT), which contain a large amount of linoleic acid (LOA, 18:2), a n-6 polyunsaturated fatty acid (PUFA), serving as a precursor of arachidonic acid (AA)
Effects of lipid emulsions on lung morphology and inflammation after induction of ARDS Mice were infused with NaCl, LCT, LCT/medium-chain triglycerides (MCT) or LCT/ MCT/fish oil (FO) over three days, followed by intra-tracheal application of LPS 24 h prior to being sacrificed
Summary
Acute respiratory distress syndrome (ARDS) is a major cause of mortality in intensive care units. Patients with ARDS often require parenteral nutrition with lipid emulsions as essential components. The incidence of ARDS was 4.5 to 7.1% in all patients admitted to an intensive care unit (ICU) [2,3] This percentage increases to 12.5% when considering only patients. Lipid emulsions are considered as essential components of clinical parenteral nutrition regimens applied to critically ill patients. In critically ill patients suffering from sepsis or ARDS, enteral supplementation of n-3-based lipid emulsions reduced mortality and displayed anti-inflammatory properties [5]. A large multi-center study, conducted by the ARDSnet, was recently published and investigatedg the effects of an enteral supplementation of n-3 fatty acids in ARDS patients [12]. Due to the inconsistency of data concerning the enteral use of n-3 fatty acids in ARDS, there is an on-going debate in the scientific community with no final recommendation available at the moment
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