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Cited by 67Clinical Nutrition and GastroenterologyHyperglycemia and glycemic control in critically ill and hospitalized patientsFatty Acid Research and Health

Omega-3 fatty acid-containing parenteral nutrition in ICU patients: systematic review with meta-analysis and cost-effectiveness analysis

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Pradelli, Lorenzo, Klek, Stanislaw, Mayer, Konstantin, Omar Alsaleh, Abdul Jabbar, Rosenthal, Martin D., Heller, Axel R., Muscaritoli, Maurizio·2020·Critical Care
DOI 10.1186/s13054-020-03356-wPMC PMC7607851
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Abstract

Background: Omega-3 (ω-3) fatty acid (FA)-containing parenteral nutrition (PN) is associated with significant improvements in patient outcomes compared with standard PN regimens without ω-3 FA lipid emulsions. Here, we evaluate the impact of ω-3 FA-containing PN versus standard PN on clinical outcomes and costs in adult intensive care unit (ICU) patients using a meta-analysis and subsequent cost-effectiveness analysis from the perspective of a hospital operating in five European countries (France, Germany, Italy, Spain, UK) and the US. Methods: We present a pharmacoeconomic simulation based on a systematic literature review with meta-analysis. Clinical outcomes and costs comparing ω-3 FA-containing PN with standard PN were evaluated in adult ICU patients eligible to receive PN covering at least 70% of their total energy requirements and in the subgroup of critically ill ICU patients (mean ICU stay > 48 h). The meta-analysis with the co-primary outcomes of infection rate and mortality rate was based on randomized controlled trial data retrieved via a systematic literature review; resulting efficacy data were subsequently employed in country-specific cost-effectiveness analyses. Results: In adult ICU patients, ω-3 FA-containing PN versus standard PN was associated with significant reductions in the relative risk (RR) of infection (RR 0.62; 95% CI 0.45, 0.86; p = 0.004), hospital length of stay (HLOS) (− 3.05 days; 95% CI − 5.03, − 1.07; p = 0.003) and ICU length of stay (LOS) (− 1.89 days; 95% CI − 3.33, − 0.45; p = 0.01). In critically ill ICU patients, ω-3 FA-containing PN was associated with similar reductions in infection rates (RR 0.65; 95% CI 0.46, 0.94; p = 0.02), HLOS (− 3.98 days; 95% CI − 6.90, − 1.06; p = 0.008) and ICU LOS (− 2.14 days; 95% CI − 3.89, − 0.40; p = 0.02). Overall hospital episode costs were reduced in all six countries using ω-3 FA-containing PN compared to standard PN, ranging from €-3156 ± 1404 in Spain to €-9586 ± 4157 in the US. Conclusion: These analyses demonstrate that ω-3 FA-containing PN is associated with statistically and clinically significant improvement in patient outcomes. Its use is also predicted to yield cost savings compared to standard PN, rendering ω-3 FA-containing PN an attractive cost-saving alternative across different health care systems. Study registration: PROSPERO CRD42019129311.

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  • Pradelli et al. conducted a meta-analysis of 24 RCTs comparing fish oil-enriched PN with standard (non-fish oil-enriched) PN in adult patients in the ICU.

    “Pradelli et al. [96] conducted a meta-analysis of 24 RCTs comparing fish oil-enriched PN with standard (non-fish oil-enriched) PN in adult patients in the ICU.”

    From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [96]

  • In critically ill ICU patients, fish oil was associated with reductions in infections (RR 0.65, 95% CI 0.46e0.94), ICU LOS (-2.14 days, 95% CI -3.89 to -0.40), and hospital length of stay (-3.98 days, 95% CI -6.90 to -1.06), but with a non-significant reduction in 30-day mortality in all ICU patients (RR 0.90, 95% CI 0.69e1.16).

    “In critically ill ICU patients, fish oil was associated with reductions in infections (RR 0.65, 95% CI 0.46e0.94),ICU LOS (À2.14 days, 95% CI -3.89 to À0.40), and hospital length of stay (À3.98 days, 95% CI -6.90 to À1.06), but with a non-significant reduction in 30-day mortality in all ICU patients (RR 0.90, 95% CI 0.69e1.16).”

    From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [96]

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Research works printed but not linked: 48

  1. [1]Calder PC Adolph M Deutz NE Grau T Innes JK Klek S Lipids in the intensive care unit: recommendations from the ESPEN Expert Group Clin Nutr 2018 37 1 1 18 10.1016/j.clnu.2017.08.032 28935438 · DOI · Paper page
  2. [2]Raman M Almutairdi A Mulesa L Alberda C Beattie C Gramlich L Parenteral nutrition and lipids Nutrients 2017 9 4 388 10.3390/nu9040388 PMC5409727 28420095 · DOI
  3. [3]Klek S Omega-3 fatty acids in modern parenteral nutrition: a review of the current evidence J Clin Med 2016 5 3 34 10.3390/jcm5030034 PMC4810105 26959070 · DOI
  4. [4]Carpentier YA Dupont IE Advances in intravenous lipid emulsions World J Surg 2000 24 12 1493 1497 10.1007/s002680010267 11193713 · DOI
  5. [5]Bae HJ Lee GY Seong JM Gwak HS Outcomes with perioperative fat emulsions containing omega-3 fatty acid: a meta-analysis of randomized controlled trials Am J Health Syst Pharm 2017 74 12 904 918 10.2146/ajhp151015 28596227 · DOI
  6. [6]Berger MM Tappy L Revelly JP Koletzko BV Gepert J Corpataux JM Fish oil after abdominal aorta aneurysm surgery Eur J Clin Nutr 2008 62 9 1116 1122 10.1038/sj.ejcn.1602817 17538537 · DOI · Paper page
  7. [7]Li NN Zhou Y Qin XP Chen Y He D Feng JY Does intravenous fish oil benefit patients post-surgery? A meta-analysis of randomised controlled trials Clin Nutr 2014 33 2 226 239 10.1016/j.clnu.2013.08.013 24084088 · DOI
  8. [8]Pradelli L Mayer K Klek S Omar Alsaleh AJ Clark RAC Rosenthal MD Omega-3 fatty-acid enriched parenteral nutrition in hospitalized patients: systematic review with meta-analysis and trial sequential analysis JPEN J Parenter Enteral Nutr 2020 44 1 44 57 10.1002/jpen.1672 31250474 PMC7003746 · DOI
  9. [9]Wei C Hua J Bin C Klassen K Impact of lipid emulsion containing fish oil on outcomes of surgical patients: systematic review of randomized controlled trials from Europe and Asia Nutrition 2010 26 5 474 481 10.1016/j.nut.2009.09.011 20116213 · DOI
  10. [10]Wichmann MW Thul P Czarnetzki HD Morlion BJ Kemen M Jauch KW Evaluation of clinical safety and beneficial effects of a fish oil containing lipid emulsion (Lipoplus, MLF541): data from a prospective, randomized, multicenter trial Crit Care Med 2007 35 3 700 706 10.1097/01.CCM.0000257465.60287.AC 17261965 · DOI
  11. [11]Xie H Chang YN Omega-3 polyunsaturated fatty acids in the prevention of postoperative complications in colorectal cancer: a meta-analysis Onco Targets Ther 2016 9 7435 7443 10.2147/OTT.S113575 28003759 PMC5158178 · DOI
  12. [12]Manzanares W Langlois PL Dhaliwal R Lemieux M Heyland DK Intravenous fish oil lipid emulsions in critically ill patients: an updated systematic review and meta-analysis Crit Care 2015 19 167 10.1186/s13054-015-0888-7 25879776 PMC4404291 · DOI · Paper page
  13. [13]Grau-Carmona T Bonet-Saris A Garcia-de-Lorenzo A Sanchez-Alvarez C Rodriguez-Pozo A Acosta-Escribano J Influence of n-3 polyunsaturated fatty acids enriched lipid emulsions on nosocomial infections and clinical outcomes in critically ill patients: ICU lipids study Crit Care Med 2015 43 1 31 39 10.1097/CCM.0000000000000612 25226273 · DOI · Paper page
  14. [14]Palmer AJ Ho CK Ajibola O Avenell A The role of omega-3 fatty acid supplemented parenteral nutrition in critical illness in adults: a systematic review and meta-analysis Crit Care Med 2013 41 1 307 316 10.1097/CCM.0b013e3182657578 23128380 · DOI · Paper page
  15. [15]Lu C Sharma S McIntyre L Rhodes A Evans L Almenawer S Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials Ann Intensive Care 2017 7 1 58 10.1186/s13613-017-0282-5 28585162 PMC5459780 · DOI · Paper page
  16. [16]Tao W Li PS Shen Z Shu YS Liu S Effects of omega-3 fatty acid nutrition on mortality in septic patients: a meta-analysis of randomized controlled trials BMC Anesthesiol 2016 16 1 39 10.1186/s12871-016-0200-7 27430341 PMC4950703 · DOI · Paper page
  17. [17]Kreymann KG Heyland DK de Heer G Elke G Intravenous fish oil in critically ill and surgical patients—historical remarks and critical appraisal Clin Nutr 2018 37 3 1075 1081 10.1016/j.clnu.2017.07.006 28747247 · DOI · Paper page
  18. [18]Hassan M Tuckman HP Patrick RH Kountz DS Kohn JL Hospital length of stay and probability of acquiring infection Int J Pharm Healthc Mark 2010 4 4 324 338 10.1108/17506121011095182 · DOI
  19. [19]Koukourikos K Tsaloglidou A Kourkouta L Muscle atrophy in intensive care unit patients Acta Inform Med 2014 22 6 406 410 10.5455/aim.2014.22.406-410 25684851 PMC4315632 · DOI
  20. [21]Sharma K Mogensen KM Robinson MK Pathophysiology of critical illness and role of nutrition Nutr Clin Pract 2019 34 1 12 22 10.1002/ncp.10232 30580456 · DOI
  21. [22]Oshima T Pichard C Parenteral nutrition: never say never Crit Care 2015 19 Suppl 3 S5 10.1186/cc14723 26728859 PMC4698923 · DOI
  22. [23]Thibault R Heidegger CP Berger MM Pichard C Parenteral nutrition in the intensive care unit: cautious use improves outcome Swiss Med Wkly 2014 144 w13997 25144728
  23. [24]Preiser JC Ichai C Orban JC Groeneveld AB Metabolic response to the stress of critical illness Br J Anaesth 2014 113 6 945 954 10.1093/bja/aeu187 24970271 · DOI
  24. [25]Ali NA O'Brien JM Jr Hoffmann SP Phillips G Garland A Finley JC Acquired weakness, handgrip strength, and mortality in critically ill patients Am J Respir Crit Care Med 2008 178 3 261 268 10.1164/rccm.200712-1829OC 18511703 · DOI
  25. [26]De Jonghe B Sharshar T Lefaucheur JP Authier FJ Durand-Zaleski I Boussarsar M Paresis acquired in the intensive care unit: a prospective multicenter study JAMA 2002 288 22 2859 2867 10.1001/jama.288.22.2859 12472328 · DOI
  26. [27]Herridge MS Tansey CM Matte A Tomlinson G Diaz-Granados N Cooper A Functional disability 5 years after acute respiratory distress syndrome N Engl J Med 2011 364 14 1293 1304 10.1056/NEJMoa1011802 21470008 · DOI
  27. [28]Heyland DK Stapleton RD Mourtzakis M Hough CL Morris P Deutz NE Combining nutrition and exercise to optimize survival and recovery from critical illness: conceptual and methodological issues Clin Nutr 2016 35 5 1196 1206 10.1016/j.clnu.2015.07.003 26212171 · DOI
  28. [29]Monk DN Plank LD Franch-Arcas G Finn PJ Streat SJ Hill GL Sequential changes in the metabolic response in critically injured patients during the first 25 days after blunt trauma Ann Surg 1996 223 4 395 405 10.1097/00000658-199604000-00008 8633918 PMC1235135 · DOI
  29. [30]Puthucheary Z Montgomery H Moxham J Harridge S Hart N Structure to function: muscle failure in critically ill patients J Physiol 2010 588 Pt 23 4641 4648 10.1113/jphysiol.2010.197632 20961998 PMC3010132 · DOI
  30. [31]Wischmeyer PE San-Millan I Winning the war against ICU-acquired weakness: new innovations in nutrition and exercise physiology Crit Care 2015 19 Suppl 3 S6 10.1186/cc14724 26728966 PMC4699141 · DOI · Paper page
  31. [32]Alberda C Gramlich L Jones N Jeejeebhoy K Day AG Dhaliwal R The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observational study Intensive Care Med 2009 35 10 1728 1737 10.1007/s00134-009-1567-4 19572118 · DOI · Paper page
  32. [33]Petros S Horbach M Seidel F Weidhase L Hypocaloric vs normocaloric nutrition in critically ill patients: a prospective randomized pilot trial JPEN J Parenter Enteral Nutr 2016 40 2 242 249 10.1177/0148607114528980 24699555 · DOI · Paper page
  33. [34]Faisy C Candela Llerena M Savalle M Mainardi JL Fagon JY Early ICU energy deficit is a risk factor for Staphylococcus aureus ventilator-associated pneumonia Chest 2011 140 5 1254 1260 10.1378/chest.11-1499 21903738 · DOI
  34. [35]Dvir D Cohen J Singer P Computerized energy balance and complications in critically ill patients: an observational study Clin Nutr 2006 25 1 37 44 10.1016/j.clnu.2005.10.010 16321459 · DOI · Paper page
  35. [37]Liberati A Altman DG Tetzlaff J Mulrow C Gotzsche PC Ioannidis JP The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration BMJ 2009 339 b2700 10.1136/bmj.b2700 19622552 PMC2714672 · DOI · Paper page
  36. [38]Hill SR Cost-effectiveness analysis for clinicians BMC Med 2012 10 10 10.1186/1741-7015-10-10 22296610 PMC3395827 · DOI
  37. [39]Pradelli L Mayer K Klek S Omar Alsaleh AJ Rosenthal M Heller AR SUN-LB640: omega-3 fatty-acid enriched parenteral nutrition regimens in hospitalized patients in EU5 countries: a pharmacoeconomic analysis Clin Nutr 2019 38 S297 10.1016/S0261-5614(19)32606-8 · DOI
  38. [40]Levy MM Fink MP Marshall JC Abraham E Angus D Cook D 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference Crit Care Med 2003 31 4 1250 1256 10.1097/01.CCM.0000050454.01978.3B 12682500 · DOI
  39. [41]Magee G Zaloga GP Turpin RS Sanon M A retrospective, observational study of patient outcomes for critically ill patients receiving parenteral nutrition Value Health 2014 17 4 328 333 10.1016/j.jval.2014.02.009 24968991 · DOI
  40. [43]Pradelli L Mayer K Klek S Omar Alsaleh AJ Clark RAC Rosenthal MD Omega-3 fatty-acid enriched parenteral nutrition in hospitalized patients: systematic review with meta-analysis and trial sequential analysis J Parenter Enteral Nutr 2019 1 44 57 PMC7003746 31250474
  41. [44]Honeywell S Zelig R Rigassio RD Impact of intravenous lipid emulsions containing fish oil on clinical outcomes in critically ill surgical patients: a literature review Nutr Clin Pract 2019 34 1 112 122 10.1002/ncp.10224 30516298 · DOI
  42. [45]Chen H Wang W Hong C Zhang M Hong Y Wang S Omega-3 fish oil reduces mortality due to severe sepsis with acute gastrointestinal injury Grade III Pharmacogn Mag 2017 13 51 407 412 10.4103/pm.pm_418_16 28839364 PMC5551357 · DOI
  43. [46]Kamdar BB Huang M Dinglas VD Colantuoni E von Wachter TM Hopkins RO Joblessness and lost earnings after acute respiratory distress syndrome in a 1-year national multicenter study Am J Respir Crit Care Med 2017 196 8 1012 1020 10.1164/rccm.201611-2327OC 28448162 PMC5649982 · DOI
  44. [47]Kaukonen KM Bailey M Suzuki S Pilcher D Bellomo R Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012 JAMA 2014 311 13 1308 1316 10.1001/jama.2014.2637 24638143 · DOI
  45. [48]Tan SS Bakker J Hoogendoorn ME Kapila A Martin J Pezzi A Direct cost analysis of intensive care unit stay in four European countries: applying a standardized costing methodology Value Health 2012 15 1 81 86 10.1016/j.jval.2011.09.007 22264975 · DOI
  46. [49]Halpern NA Goldman DA Tan KS Pastores SM Trends in critical care beds and use among population groups and Medicare and Medicaid beneficiaries in the United States: 2000–2010 Crit Care Med 2016 44 8 1490 1499 10.1097/CCM.0000000000001722 27136721 PMC5520973 · DOI
  47. [50]van Walraven C Trends in 1-year survival of people admitted to hospital in Ontario, 1994–2009 CMAJ 2013 185 16 E755 E762 10.1503/cmaj.130875 24082022 PMC3826363 · DOI
  48. [51]Reardon PM Fernando SM Van Katwyk S Thavorn K Kobewka D Tanuseputro P Characteristics, outcomes, and cost patterns of high-cost patients in the intensive care unit Crit Care Res Pract 2018 2018 5452683 30245873 PMC6139208

Cited by

Sorted by citations

Authors
Pradelli, L., Klek, S., Mayer, K., Omar Alsaleh, A. J., Rosenthal, M. D., Heller, A. R., & Muscaritoli, M.
Affiliations
  • University of Florida Health (US)
  • University of Augsburg (DE)
  • Sapienza University of Rome (IT)
Corresponding author
Pradelli, Lorenzo
ORCID
Venue
Critical Care
Publisher
Springer Science and Business Media LLC
Published
2020-11-03
Volume
24
Issue
1
Pages
634-634
ISSN
1364-8535 (ISSN-L)
DOI
10.1186/s13054-020-03356-w
PMC
PMC7607851
OpenAlex
W3097175617
Cited by
67
References
1
Citations by year
2026: 8 · 2025: 15 · 2024: 17 · 2023: 12 · 2022: 7 · 2021: 8
FWCI
0.83
Type
journal article
Language
en
Open access
Licence
Locations
  • Critical Care (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
  • OPUS (Augsburg University) (submittedVersion, cc-by)
Funders
Fresenius Kabi
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
  • Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
Keywords
omega-3 fatty acids, parenteral nutrition, lipid emulsions, intensive care unit patients, critically ill patients, infection rate, mortality, length of hospital stay, ICU length of stay, cost-effectiveness, hospital costs, hospital operating costs
MeSH terms
Cost-Benefit Analysis, France, Germany, Humans, Intensive Care Units, Italy, Length of Stay, Parenteral Nutrition, Spain, Time Factors, United States, Fatty Acids, Omega-3, Critical Illness, Treatment Outcome

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