Long-chain Fat Emulsion Research Articles

Intralipid postconditioning in patients of cardiac surgery undergoing cardiopulmonary bypass (iCPB): study protocol for a randomized controlled trial

BackgroundIntralipid is a necessary fatty acid carrier that has been safely used as an energy supplier in the clinic. It has played an important role in rescuing the cardiac arrest caused by local anesthetic toxicity. In recent years, experimental studies have shown that intralipid postconditioning (ILPC) could reduce myocardial ischemic/reperfusion (I/R) injuries. Our research group has innovatively conducted a pilot randomized controlled trial (RCT), and the results showed that ILPC could reduce the release of cTnT and CK-MB, biomarkers of myocardial I/R injury, in valve replacement surgery. However, the potential effects of ILPC on the clinical outcome of adult cardiac surgery patients are unclear. Intralipid postconditioning in patients of cardiac surgery undergoing cardiopulmonary bypass (iCPB) trial is aimed to further study whether ILPC could improve short-term and long-term clinical outcome, as well as cardiac function in adult cardiac surgery patients.MethodsThe iCPB trial is an ongoing, single-center, prospective, double-blinded, large sample RCT. In total, 1000 adults undergoing cardiac surgery will be randomly allocated to either the ILPC group or the control group. The intervention group received an intravenous infusion of 2 mL/kg of 20% intralipid (medium-chain and long-chain fat emulsion injection C6~C24, Pharmaceutical) within 10 min before aortic cross-unclamping, and the control group received an equivalent volume of normal saline. The primary endpoints are complex morbidity of major complications during hospitalization and all-cause mortality within 30 days after surgery. The secondary endpoints include (1) all-cause mortality 6 months and 1 year postoperatively; (2) the quality of life within 1 year after surgery, using the QoR-15 questionnaire; (3) the postoperative cardiac function evaluated by LVEF, LVEDS, and LVEDD, and the myocardial injury evaluated by CK-MB, cTnT, and BNP; and (4) short-term clinical outcomes during hospitalization and total cost are also detailed evaluated.DiscussionThe iCPB trial is the first to explore ILPC on the clinical outcome of adult cardiac surgery patients. The results are expected to provide potential evidences about whether ILPC could reduce the morbidity and mortality and improve the cardiac function and quality of life. Therefore, the results will provide a rationale for the evaluation of the potentially clinically relevant benefit of intralipid therapy.Trial registrationChictr.org.cn ChiCTR1900024387. Prospectively registered on 9 July 2019.

Effects of structured fat emulsion and medium / long chain fat emulsion on patients after hepatectomy

Objective To analyze the effects of structured fat emulsion and medium/long chain fat emulsion on blood lipids, immune cells and acute inflammation after hepatectomy for hepatocellular carcinoma. Methods Total of 60 patients with hepatocellular carcinoma who underwent hepatectomy in Henan People's Hospital (Zhengzhou University People's Hospital) from January 2013 to March 2017 were divided into experimental group (using structured fat emulsion) and control group (using medium/long chain fat emulsion), 30 cases in each group. Triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), total cholesterol (TC), T lymphocyte level, fibrinogen (FIB), C-reactive protein (CRP), prostaglandin E2 (PGE2) were detected before and 2, 4, 6 and 8 days after infusion. Results There were no significant differences in LDL-C, HDL-C, TG and TC between the two groups before infusion (P>0.05). On the 2nd day of parenteral nutrition infusion, the level of blood lipids in both groups was higher than experimental group before infusion; on the 4th, 6th and 8th day of infusion, LDL-C, HDL-C, TG and TC in the control group were higher than those in the experimental group (P<0.05). After parenteral nutrition infusion, the levels of CD3+ , CD4+ , CD8+ , CD4+ /CD8+ in both groups were higher than experimental group before infusion, and the experimental group was higher than the control group, the differences were statistically significant (P<0.05). Compared with before infusion, level of FIB, CRP and PGE2 began to increase on the 2nd day of infusion, and the differences were statistically significant (P<0.05). On the 2nd, 4th, 6th and 8th day, CRP in the control group was higher than experimental group. And resepeatively (19.12±5.84) mg/ml vs. (13.76±2.36) mg/ml, (31.67±8.68) mg/ml vs. (17.21±2.66) mg/ml, (22.15±8.33) mg/ml vs. (12.48±0.63) mg/ml, (9.65±4.66) mg/ml vs. (7.52±0.99) mg/ml, and PGE2 were also higher than that in the experimental group (P<0.05). Conclusion Structured fat emulsion is superior to medium/long chain fat emulsion in improving blood lipid, immune cells and inflammatory reaction in patients after hepatectomy. Key words: Carcinoma, hepatocellular; Fat emulsions, intravenous; Lipid metabolism

Comparative study on the nutritional status effect of two different parenteral nutrition solutions in early preterm infants

Objective To compare the effects of two different parenteral nutrition solutions on nutritional status of premature infants,such as the early physical,serum prealbumin,retinol binding protein and albumin.Methods We collected 61 cases of premature infants in neonatal intensive care unit of the Third Military Medical University Xinqiao Hospital,which were divided into 2 groups of traditional parenteral nutrition (TTPN) and early parenteral nutrition (ETPN).Group TTPN geted 6％ paediatric compound amino acid 0.5 g/(kg·d) at24 hours after birth,daily increasing 0.25 ～0.5 g/(kg·d),up to 3.0 g/(kg·d).The 20％ long-chain fat emulsion 0.5 g/(kg ·d) was applied at 3 days after birth,daily increasing 0.25 ～ 0.5 g/(kg·d),up to 3.0 g/(kg·d).Group ETPN get 6％ paediatric compound amino acid 1 g/(kg·d) at 12 ～24 hours after birth,daily increasing 0.5 g/(kg·d),up to 3.0 ～ 0.5 g/(kg· d).The 20％ long-chain fat emulsion 0.5 ～ 1.0 g/(kg·d) was applied after 24 hours after birth,daily increasing 0.5 g/(kg· d),up to 3.0 g/(kg· d).We calculate calorie and amino acid intake of the two groups,and compared the weight,length,head circumference growth,serum prealbumin,retinol-binding protein and albumin levels of the two groups.Results The amino acid and total caloric intake of Group ETPN were significantly higher than those of Group TTPN (P ＜ 0.05).No statistical differences in the albumin,prealbumin,and retinol binding protein level of the two groups at birth (P ＞ 0.05).However,the prealbumin and retinol-binding protein level of group ETPN significantly higher than those of Group TTPN (P ＜ 0.05) at 7 days after birth.Conclusion Early parenteral nutrition in early life can effectively improve physical growth and nutrient metabolism status of premature infants.Prealbumin and retinol-binding protein are sensitive to evaluate the protein nutritional status in premature infants. Key words: Premature infants; Parenteral nutrition; Prealbumin; Retinol binding protein

The effect of lipid emulsion pretreatment on plasma concentrations and pharmacodynamics of ropivacaine after epidural administration in adults

Objective To determine whether there is a change of ropivacaine plasma concentration and analgesia efficacy associated to the pretreatment of lipid emulsion (LE) during epidural anesthesia in adults undergoing lower limb operations.Method Twenty-nine adult patients aged 18 to 65 years,ASA Ⅰ-Ⅱ,scheduled for elective lower limb operations under epidural anesthesia,were invited to participate in the study.The patients were randomized into three groups:control group(NS group,n=11),medium and long chain fat emulsion group(MLE group,n=8) and long chain fat emulsion group(LLE group,n=10).Three groups of patients were pretreated with 0.9 ％ saline,20 ％ LLE or 20 ％ MLE,at 2 ml·kg-1·h-1 for 30 min via left upper limb vein.2 mg/kg (including the test dose) of ropivacaine was injected through the epidural catheter.Hemodynamic parameters were recorded.Sensory block and the degree of motor block was determined.Ropivacaine plasma concentrations were measured from artery plasma samples at 1,5,10,15,30,45,60,90,120 min after total ropivacaine was given.Results No significant differences were observed between groups in onset time of sensory and motor block,time to maximum spread of sensory block,the segments of spinal nerve block,persistent time of sensory and motor block.The plasma ropivacaine concentration among all groups had no significant differences at each time.Conclusions Pretreatment of LLE and MLE had no effect on plasma concentration and pharmacodynamics of ropivacaine during epidural anesthesia in adults undergoing lower limb operations. Key words: Lipid emulsion; Local anesthetic,ropivacaine; Pharmacodynamics; Plasma concentration; Intraspinal anesthesia, Epidural

Introduction of a ketogenic diet in young infants.

The ketogenic diet is a rational treatment for pyruvate dehydrogenase complex deficiency (McKusick 312170) and GLUT1 deficiency syndrome (McKusick 138140). An increasing number of patients are diagnosed in early infancy, but few data are available on the introduction of a ketogenic diet in this age group. GLUT1 deficiency syndrome was suspected in four infants presenting with seizures and unexplained hypoglycorrhachia. A ketogenic diet was introduced at 6-28 weeks of age. Ketosis was initiated by fasting, monitored by bedside blood glucose and 3-hydroxybutyrate determinations, and was maintained successfully using supplemented carbohydrate-free infant formula and emulgated triglycerides. All patients developed ketosis within 24 h. 3-Hydroxybutyrate concentrations available at the bedside correlated inversely with the base excess. At glucose levels < or = 40 mg/dl patients remained asymptomatic in the presence of ketones. The ketogenic formula was tolerated well, parental compliance was good, and all patients remained seizure-free on the diet. GLUT1 deficiency was confirmed in two patients; the diet was discontinued in the other two patients. In one infant, failure to thrive on medium-chain triglycerides was effectively reversed using long-chain triglycerides. Urine dipstick analyses failed to detect ketosis in another infant. Adverse effects of the diet were limited to renal stones in one patient. The ketogenic diet can be introduced and maintained successfully in young infants using long-chain fat emulsion. Monitoring 3-hydroxybutyrate at the bedside was useful for metabolic control and superior to urine dipstick analysis. Seizure control was effective and adverse effects were limited, but evaluation of the long-term effects of the ketogenic diet in this age group must await ongoing studies.

Long-Chain versus Medium and Long-Chain Triglyceride-based Fat Emulsion in Parenteral Nutrition of Severe Head Trauma Patients

In order to assess the metabolic value of medium-chain triglycerides (MCT) in severely stressed intensive care unit patients, two fat emulsions containing either long-chain triglycerides (LCT), or a mixture of 50% MCT and 50% LCT were compared in 24 head trauma patients over a 10 day period. Variations of serum triglyceride, non-esterified fatty acid, glycerol and phospholipid concentrations remained comparable after both lipid infusions. Bilirubin, alkaline phosphatase and transaminase plasma levels were altered in both groups without any significant differences or clinical consequences. Cumulative nitrogen balance remained negative (-10 g N. day-1 i.e. -100 g N. 10 days-1) and comparable in both groups. However, thyroxin-binding prealbumin concentrations increased significantly in patients receiving the MCT/LCT mixture. It is concluded that MCT might have a beneficial effect on visceral protein metabolism after trauma.