Modulation of Dietary Lipid Composition During Acute Respiratory Distress Syndrome: Systematic Review and Meta‐Analysis
Abstract
Background: Pharmaconutrition including omega‐3 and competitive analogs of omega‐6 fatty acids has been used to modulate the inflammatory response during acute respiratory distress syndrome (ARDS). The clinical benefit of this approach when assessed in prospective randomized clinical trials has been inconsistent. We tried to assess the reasons for the conflicting results, including the possible influence of the composition of the control solution. Methods: We collected data from studies listed in PubMed, Ovid, the Cochrane Database of Systematic Reviews, Embase, the U.S. National Institute of Health database, and the ARDSnet database up to March 2013. We included all trials that evaluated effects of enteral pharmaconutrition vs a control solution on mortality, ventilator‐free days, length of stay (LOS) in the intensive care unit (ICU), and ICU‐free days. A sensitivity analysis was carried out to study the influence of the lipid content of the control solution. Results: We found 7 eligible studies (802 patients; 405 randomized to pharmaconutrition). The aggregated results showed no overall effect on mortality (risk ratio [RR] = 0.83 [0.55–1.25], P = .37), but there was a mortality benefit when only studies in which pharmaconutrition was compared to a lipid‐rich control solution were considered (RR = 0.57 [0.41–0.78], P < .001). ICU LOS was shorter in patients randomized to pharmaconutrition (RR = 0.5 [0.85–0.16]). Conclusion: Use of enteral pharmaconutrition in patients with ARDS was associated with decreased mortality only when the comparator solution contained a greater amount of lipid than is currently recommended. Hence, there is insufficient evidence to support the use of enteral pharmaconutrition in ARDS.
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Santacruz Herrera et al. reported that enteral substitution including ω-3 PUFAs and competitive analogs of ω-6 PUFAs was associated with decreased mortality when the comparator solution contained a higher quantity of ω-6 PUFAs and a far greater amount of lipid than recommended in clinical practice.
“Analyzing the same ARDS patient population, Santacruz Herrera et al. reported that enteral substitution including ω-3 PUFAs and competitive analogs of ω-6 PUFAs was associated with decreased mortality when the comparator solution contained a higher quantity of ω-6 PUFAs and a far greater amount of lipid than recommended in clinical practice [69].”
From Nutrition in Sepsis: A Bench-to-Bedside Review. (2020) · cites this paper as [69]
In the study of pre-emptive administration, membrane content of EPA and DHA was very low at baseline and was hardly corrected with omega-3 and borage oil administration.
“In this study, the membrane content of EPA and DHA was very low at baseline and was hardly corrected with omega-3 and borage oil administration”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [245]
Enteral formulae enriched in borage oil and/or omega-3 fatty acids have been administered in patients suffering from ARDS, acute lung injury and sepsis with positive effects regarding length of stay, length of ventilation and even mortality.
“Enteral formulae enriched in borage oil and/or omega-3 FA have been administered in patients suffering from ARDS, acute lung injury (ALI) and sepsis with positive effects regarding length of stay, length of ventilation and even mortality (239,240,245,248).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [245]
Pre-emptive administration of the same formula administered in the first 3 studies in severe, ventilated, multiple trauma patients did not find any advantage.
“The pre-emptive administration of the same formula administered in the first 3 studies in severe, ventilated, multiple trauma patients did not find any advantage (245).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [245]
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ESPEN guideline on clinical nutrition in the intensive care unit.
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Self-citationNutrition in Sepsis: A Bench-to-Bedside Review.
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- Authors
- Santacruz, C. A., Orbegozo, D., Vincent, J., & Preiser, J. C.
- Affiliations
- Université Libre de Bruxelles (BE)
- Corresponding author
- Santacruz, Carlos A.
- Venue
- Journal of Parenteral and Enteral Nutrition
- Publisher
- Wiley
- Published
- 2015-01-05
- Volume
- 39
- Issue
- 7
- Pages
- 837-846
- ISSN
- 0148-6071 (ISSN-L)
- 1941-2444
- OpenAlex
- W1998223412
- Cited by
- 27
- References
- 6
- Citations by year
- 2023: 1 · 2022: 1 · 2021: 4 · 2020: 6 · 2019: 2 · 2018: 4 · 2017: 4 · 2016: 3 · 2015: 1 · 2014: 1
- FWCI
- 0.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Journal of Parenteral and Enteral Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Keywords
- acute respiratory distress syndrome, omega-3 fatty acids, dietary fat composition, mortality, ICU length of stay, ventilator-free days, inflammation
- MeSH terms
- Dietary Fats, Enteral Nutrition, Humans, Intensive Care Units, Length of Stay, Respiratory Distress Syndrome, Fatty Acids, Omega-3, Randomized Controlled Trials as Topic, Fatty Acids, Omega-6, Parenteral Nutrition Solutions
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