Effects of a fish oil containing lipid emulsion on plasma phospholipid fatty acids, inflammatory markers, and clinical outcomes in septic patients: a randomized, controlled clinical trial
Open accessAbstract
Introduction: 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. Methods: Twenty-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. Results: Fish 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 PO 2/FiO 2 was significantly higher in the fish oil group (P = 0.047) and there were fewer patients with PO 2/FiO 2 <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. Conclusions: Inclusion 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 Registration: Clinical Trials Registration Number ISRCTN89432944
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Meta-analyses by Palmer et al., Chen et al., Pradelli et al., Manzanares et al. and Zhu et al. showed a decrease in length of stay.
“Those of Palmer et al. (267), Chen et al. (268), Pradelli et al. (269), Manzanares et al. (270) and Zhu et al. (271) showed a decrease in length of stay, while Manzanares et al. (270) and Zhu et al. (271) also showed a decrease in infections.”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [267]
The Results (Clinical outcomes; page unavailable) report a tendency toward shorter hospital stay in this randomized trial of septic ICU patients, not a finding from the five named meta-analyses. The Discussion likewise describes the reduction as a finding of this study. Our copy does not report the named meta-analyses or establish what they found. (LLM, conf=0.86)
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- Authors
- Barbosa, V. M., Miles, E. A., Calhau, C., Lafuente, E., & Calder, P. C.
- Affiliations
- Southampton General Hospital (GB)
- Universidade do Porto (PT)
- Hospital Padre Américo (PT)
- Corresponding author
- Calder, Philip C
- Venue
- Critical Care
- Published
- 2010-01-19
- Volume
- 14
- Issue
- 1
- Pages
- R5-R5
- ISSN
- 1364-8535 (ISSN-L)
- PMC
- PMC2875515
- OpenAlex
- W2118704546
- Cited by
- 180
- References
- 50
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 4 · 2023: 5 · 2022: 6 · 2021: 7 · 2020: 8 · 2019: 6 · 2018: 8 · 2017: 13 · 2016: 12 · 2015: 21 · 2014: 21 · 2013: 20 · 2012: 16
- FWCI
- 18.51
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Critical Care (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- fish oil, lipid emulsions, sepsis, parenteral nutrition, phospholipid fatty acids, eicosapentaenoic acid, phosphatidylcholine, interleukin-6, IL-10, inflammatory cytokines, eicosanoids, lipopolysaccharide stimulation, oxygenation, length of hospital stay, mortality
- MeSH terms
- Aged, Aged, 80 and over, Emulsions, Female, Fish Oils, Humans, Length of Stay, Male, Middle Aged, Phospholipids, Soybean Oil, Fatty Acids, Omega-3, Single-Blind Method, Treatment Outcome, Sepsis, Inflammation Mediators
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