Original

Intensive Care Medicine

, Volume 34, Issue 8, pp 1411-1420

Fish oil supplementation in the parenteral nutrition of critically ill medical patients: a randomised controlled trial

  • Sigrun FrieseckeAffiliated withDepartment of Internal Medicine, Ernst Moritz Arndt University of Greifswald Email author 
  • , Christian LotzeAffiliated withDepartment of Internal Medicine, Ernst Moritz Arndt University of Greifswald
  • , Jenny KöhlerAffiliated withDepartment of Internal Medicine, Ernst Moritz Arndt University of Greifswald
  • , Annegret HeinrichAffiliated withDepartment of Internal Medicine, Ernst Moritz Arndt University of Greifswald
  • , Stephan B. FelixAffiliated withDepartment of Internal Medicine, Ernst Moritz Arndt University of Greifswald
  • , Peter AbelAffiliated withDepartment of Internal Medicine, Ernst Moritz Arndt University of Greifswald

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Abstract

Objective

To test whether supplementation of parenteral nutrition with fish oil – aimed at increasing the n-3:n-6 ratio of polyunsaturated fatty acids (PUFA) to 1:2 – affects systemic inflammation and clinical outcome compared to standard parenteral nutrition with an n-3/n-6 ratio of 1:7 in medical intensive care unit (ICU) patients.

Design

Single-centre, placebo-controlled, double-blind, randomised clinical trial.

Setting

Twelve-bed medical ICU of a university hospital.

Patients

A total of 166 consecutive patients anticipated to need parenteral nutrition for more than 6 days. Patients were stratified for the presence of systemic inflammatory response syndrome (SIRS) at baseline (115 SIRS, 51 non-SIRS).

Intervention

Patients were randomly assigned to receive either a 1:1-mixture of medium-chain triglycerides (MCT) and long-chain triglycerides (LCT) with an n-3/n-6 PUFA ratio of 1:7, or the same MCT/LCT emulsion supplemented with fish oil (resulting in an n-3/n-6 ratio of 1:2).

Measurements and results

Primary endpoints were changes in interleukin 6 (IL-6) and monocyte HLA-DR expression relative to baseline. Secondary endpoints were incidence of nosocomial infections, duration of mechanical ventilation, length of ICU stay, and 28-day mortality. Bleeding complications were recorded as a possible side effect of fish oil. Between standard and intervention groups, overall as well as stratified for SIRS or non-SIRS, no significant difference was detected in any of the endpoints or frequency and severity of bleeding events.

Conclusions

In unselected critically ill medical patients, fish oil supplementation that increased the n-3/n-6 PUFA ratio to 1:2 did not affect inflammation or clinical outcome, compared to parenteral lipid nutrition with an MCT/LCT emulsion.

Keywords

Parenteral nutrition Critical illness Fish oil