Polyunsaturated Fatty Acids and Cytokines: Their Relationship in Acute Lung Injury

  • Paolo Cotogni
  • Antonella Trombetta
  • Giuliana Muzio
  • Maria Felice Brizzi
  • Rosa Angela Canuto
Living reference work entry

Abstract

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are inflammatory diseases whose clinical severity depends on the grade of inflammatory response. Inflammatory cytokines are key elements in the pathogenesis of ALI/ARDS, and the occurrence of an imbalance between pro- and anti-inflammatory cytokines leads to additional non-pulmonary organ dysfunction which contributes to excess mortality rates.

Treatment of these patients includes nutrition support with lipids, usually soybean oil-based lipid emulsions, which are rich in omega (n)-6 polyunsaturated fatty acids (PUFAs) and deficient in n-3 PUFAs; however, too much n-6 PUFAs are detrimental due to their pro-inflammatory effects. Conversely, a large amount of experimental studies and some randomized clinical trials showed the benefits of the n-3 PUFA administration in the context of ALI because of their anti-inflammatory properties. Based on these data, several scientific societies recommended in their guidelines, with an A or B grade of recommendation, the use of n-3 PUFAs in ALI/ARDS patients. However, at present, the issue of lipid therapy in ALI/ARDS is still controversial due, at least in part, to inconclusive or contradicting results in several recent clinical trials using n-3 PUFAs.

Keywords

Permeability Surfactant Carbohydrate Corticosteroid Pneumonia 

List of Abbreviations

AA

Arachidonic acid

ALI

Acute lung injury

ARDS

Acute respiratory distress syndrome

BAL

Bronchoalveolar lavage

DHA

Docosahexaenoic acid

EN

Enteral nutrition

EPA

Eicosapentaenoic acid

FA

Fatty acid

FiO2

Fractional inspired oxygen

ICU

Intensive care unit

IL

Interleukin

LOS

Length of stay

LPS

Lipopolysaccharide

LT

Leukotriene

n

Omega

PaO2

Arterial oxygen partial pressure

PG

Prostaglandin

PN

Parenteral nutrition

PUFA

Polyunsaturated fatty acid

RCT

Randomized controlled trial

TNF

Tumor necrosis factor

TX

Thromboxane

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Paolo Cotogni
    • 1
  • Antonella Trombetta
    • 2
  • Giuliana Muzio
    • 3
  • Maria Felice Brizzi
    • 2
  • Rosa Angela Canuto
    • 3
  1. 1.Department of Medicine, Anesthesiology and Intensive CareS. Giovanni Battista Hospital, University of TurinTurinItaly
  2. 2.Department of Medical SciencesUniversity of TurinTurinItaly
  3. 3.Department of Experimental Medicine and OncologyUniversity of TurinTurinItaly

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