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Crit Care. 2015 Apr 16;19:167. doi: 10.1186/s13054-015-0888-7.

Intravenous fish oil lipid emulsions in critically ill patients: an updated systematic review and meta-analysis.

Author information

1
Intensive Care Unit, Faculty of Medicine-Universidad de la República (UdeLaR) University Hospital: Dr. Manuel Quintela, Italia Av. 14th Floor, Montevideo, 11600, Uruguay. wmanzanares@adinet.com.uy.
2
Département de Anesthésie et de Réanimation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke-Hôpital Fleurimont, Sherbrooke, PQ, Canada. Pascal.Laferriere-Langlois@USherbrooke.ca.
3
Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada. dhaliwar@KGH.KARI.NET.
4
Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada. lemieuxm@KGH.KARI.NET.
5
Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada. dkh2@queensu.ca.
6
Department of Medicine, Queen's University, Kingston, ON, Canada. dkh2@queensu.ca.

Abstract

INTRODUCTION:

Intravenous fish oil (FO) lipid emulsions (LEs) are rich in ω-3 polyunsaturated fatty acids, which exhibit anti-inflammatory and immunomodulatory effects. We previously demonstrated that FO-containing LEs may be able to decrease mortality and ventilation days in patients who are critically ill. Since 2014, several additional randomized controlled trials (RCTs) of FO-containing LEs have been published. Therefore, the purpose of this systematic review was to update our previous systematic review with the aim of elucidating the efficacy of FO-containing LEs on clinical outcomes of patients who are critically ill.

METHODS:

We searched electronic databases from 1980 to 2014. We included four new RCTs conducted in critically ill adult patients in which researchers evaluated FO-containing LEs in parenterally or enterally fed patients.

RESULTS:

A total of 10 RCTs (n = 733) met inclusion criteria. The mean methodological score was 8 (range, 3 to 12). No effect on overall mortality was found. When we aggregated the results of five RCTs in which infections were reported, we found that FO-containing LEs significantly reduced infections (risk ratio (RR) = 0.64; 95% confidence interval (CI), 0.44 to 0.92; P = 0.02; heterogeneity I (2) = 0%). Subgroup analysis demonstrated that predominantly enteral nutrition-based trials showed a tendency toward a reduction in mortality (RR = 0.69; 95% CI, 0.40 to 1.18; P =0.18; heterogeneity I (2) =35%). High-quality trials showed a significant reduction in hospital length of stay (LOS) (weighted mean difference = -7.42; 95% CI, -11.89 to -2.94; P = 0.001), whereas low-quality trials had no effect (P = 0.45). The results of the test for subgroup differences in hospital LOS was significant (P = 0.001).

CONCLUSION:

FO-containing LEs may be associated with a reduction in infections and also could be associated with a reduction in duration of ventilation and hospital LOS. Further large-scale RCTs are warranted and should be aimed at consolidating potential positive treatment effects.

PMID:
25879776
PMCID:
PMC4404291
DOI:
10.1186/s13054-015-0888-7
[Indexed for MEDLINE]
Free PMC Article

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