Fish oil supplementation in the parenteral nutrition of critically ill medical patients: a randomised controlled trial
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.
Single-centre, placebo-controlled, double-blind, randomised clinical trial.
Twelve-bed medical ICU of a university hospital.
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).
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.
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.
KeywordsParenteral nutrition Critical illness Fish oil
The authors wish to thank the nursing staff of the ICU of the Department of Internal Medicine at Ernst Moritz Arndt University of Greifswald, Germany, for the diligent implementation of the complex study protocol. We also thank the staff of the institutional pharmacy for their invaluable cooperation in randomisation and in conduct of the study.
This study was supported by a research grant from Fresenius Kabi Inc., Bad Homburg, Germany. The sponsors had no influence on the concept or design of the study; on the collection, analysis, or interpretation of data; or on the preparation of this article.
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