by Quirin Notz, Zheng-Yii Lee, Johannes Menger, Gunnar Elke,
Aileen Hill, Peter Kranke, Daniel Roeder, Christopher Lotz, Patrick Meybohm,
Daren K. Heyland and Christian Stoppe
Critical Care volume 26,
Article number: 23 (2022)
Background
Parenteral lipid emulsions in critical care are
traditionally based on soybean oil (SO) and rich in pro-inflammatory omega-6
fatty acids (FAs). Parenteral nutrition (PN) strategies with the aim of
reducing omega-6 FAs may potentially decrease the morbidity and mortality in
critically ill patients.
Methods
A systematic search of MEDLINE, EMBASE, CINAHL and CENTRAL
was conducted to identify all randomized controlled trials in critically ill
patients published from inception to June 2021, which investigated clinical
omega-6 sparing effects. Two independent reviewers extracted bias risk,
treatment details, patient characteristics and clinical outcomes. Random effect
meta-analysis was performed.
Results
1054 studies were identified in our electronic search, 136 trials
were assessed for eligibility and 26 trials with 1733 critically ill patients
were included. The median methodologic score was 9 out of 14 points (95%
confidence interval [CI] 7, 10). Omega-6 FA sparing PN in comparison with
traditional lipid emulsions did not decrease overall mortality (20 studies;
risk ratio [RR] 0.91; 95% CI 0.76, 1.10; p = 0.34) but hospital length of
stay was substantially reduced (6 studies; weighted mean difference [WMD] − 6.88;
95% CI − 11.27, − 2.49; p = 0.002). Among the different lipid emulsions,
fish oil (FO) containing PN reduced the length of intensive care (8 studies;
WMD − 3.53; 95% CI − 6.16, − 0.90; p = 0.009) and rate of infectious
complications (4 studies; RR 0.65; 95% CI 0.44, 0.95; p = 0.03). When FO
was administered as a stand-alone medication outside PN, potential mortality
benefits were observed compared to standard care.
Conclusion
Overall, these findings highlight distinctive omega-6
sparing effects attributed to PN. Among the different lipid emulsions, FO in
combination with PN or as a stand-alone treatment may have the greatest
clinical impact.
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