Omega-6 sparing effects of parenteral lipid emulsions—an updated systematic review and meta-analysis on clinical outcomes in critically ill patients
Abstract Background Parenteral lipid emulsions in critical care are traditionally based on soybean oil (SO) and rich in pro-inflammatory omega-6 fatty acids (FAs). Parenteral nutrition (PN) strategies with the aim of reducing omega-6 FAs may potentially decrease the morbidity and mortality in critic...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-01-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-022-03896-3 |
| _version_ | 1819261368130338816 |
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| author | Quirin Notz Zheng-Yii Lee Johannes Menger Gunnar Elke Aileen Hill Peter Kranke Daniel Roeder Christopher Lotz Patrick Meybohm Daren K. Heyland Christian Stoppe |
| author_facet | Quirin Notz Zheng-Yii Lee Johannes Menger Gunnar Elke Aileen Hill Peter Kranke Daniel Roeder Christopher Lotz Patrick Meybohm Daren K. Heyland Christian Stoppe |
| author_sort | Quirin Notz |
| collection | DOAJ |
| description | Abstract Background Parenteral lipid emulsions in critical care are traditionally based on soybean oil (SO) and rich in pro-inflammatory omega-6 fatty acids (FAs). Parenteral nutrition (PN) strategies with the aim of reducing omega-6 FAs may potentially decrease the morbidity and mortality in critically ill patients. Methods A systematic search of MEDLINE, EMBASE, CINAHL and CENTRAL was conducted to identify all randomized controlled trials in critically ill patients published from inception to June 2021, which investigated clinical omega-6 sparing effects. Two independent reviewers extracted bias risk, treatment details, patient characteristics and clinical outcomes. Random effect meta-analysis was performed. Results 1054 studies were identified in our electronic search, 136 trials were assessed for eligibility and 26 trials with 1733 critically ill patients were included. The median methodologic score was 9 out of 14 points (95% confidence interval [CI] 7, 10). Omega-6 FA sparing PN in comparison with traditional lipid emulsions did not decrease overall mortality (20 studies; risk ratio [RR] 0.91; 95% CI 0.76, 1.10; p = 0.34) but hospital length of stay was substantially reduced (6 studies; weighted mean difference [WMD] − 6.88; 95% CI − 11.27, − 2.49; p = 0.002). Among the different lipid emulsions, fish oil (FO) containing PN reduced the length of intensive care (8 studies; WMD − 3.53; 95% CI − 6.16, − 0.90; p = 0.009) and rate of infectious complications (4 studies; RR 0.65; 95% CI 0.44, 0.95; p = 0.03). When FO was administered as a stand-alone medication outside PN, potential mortality benefits were observed compared to standard care. Conclusion Overall, these findings highlight distinctive omega-6 sparing effects attributed to PN. Among the different lipid emulsions, FO in combination with PN or as a stand-alone treatment may have the greatest clinical impact. Trial registration PROSPERO international prospective database of systematic reviews (CRD42021259238). Graphical abstract |
| first_indexed | 2024-12-23T19:40:41Z |
| format | Article |
| id | doaj.art-3fed0f63a14f434594d42725ad6169e3 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-23T19:40:41Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-3fed0f63a14f434594d42725ad6169e32022-12-21T17:33:40ZengBMCCritical Care1364-85352022-01-0126111110.1186/s13054-022-03896-3Omega-6 sparing effects of parenteral lipid emulsions—an updated systematic review and meta-analysis on clinical outcomes in critically ill patientsQuirin Notz0Zheng-Yii Lee1Johannes Menger2Gunnar Elke3Aileen Hill4Peter Kranke5Daniel Roeder6Christopher Lotz7Patrick Meybohm8Daren K. Heyland9Christian Stoppe10Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital WuerzburgDepartment of Anesthesiology, University of MalayaDepartment of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital WuerzburgDepartment of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus KielDepartment of Anesthesiology and Intensive Care Medicine, University Hospital RWTH AachenDepartment of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital WuerzburgDepartment of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital WuerzburgDepartment of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital WuerzburgDepartment of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital WuerzburgDepartment of Critical Care Medicine, Queen’s UniversityDepartment of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital WuerzburgAbstract Background Parenteral lipid emulsions in critical care are traditionally based on soybean oil (SO) and rich in pro-inflammatory omega-6 fatty acids (FAs). Parenteral nutrition (PN) strategies with the aim of reducing omega-6 FAs may potentially decrease the morbidity and mortality in critically ill patients. Methods A systematic search of MEDLINE, EMBASE, CINAHL and CENTRAL was conducted to identify all randomized controlled trials in critically ill patients published from inception to June 2021, which investigated clinical omega-6 sparing effects. Two independent reviewers extracted bias risk, treatment details, patient characteristics and clinical outcomes. Random effect meta-analysis was performed. Results 1054 studies were identified in our electronic search, 136 trials were assessed for eligibility and 26 trials with 1733 critically ill patients were included. The median methodologic score was 9 out of 14 points (95% confidence interval [CI] 7, 10). Omega-6 FA sparing PN in comparison with traditional lipid emulsions did not decrease overall mortality (20 studies; risk ratio [RR] 0.91; 95% CI 0.76, 1.10; p = 0.34) but hospital length of stay was substantially reduced (6 studies; weighted mean difference [WMD] − 6.88; 95% CI − 11.27, − 2.49; p = 0.002). Among the different lipid emulsions, fish oil (FO) containing PN reduced the length of intensive care (8 studies; WMD − 3.53; 95% CI − 6.16, − 0.90; p = 0.009) and rate of infectious complications (4 studies; RR 0.65; 95% CI 0.44, 0.95; p = 0.03). When FO was administered as a stand-alone medication outside PN, potential mortality benefits were observed compared to standard care. Conclusion Overall, these findings highlight distinctive omega-6 sparing effects attributed to PN. Among the different lipid emulsions, FO in combination with PN or as a stand-alone treatment may have the greatest clinical impact. Trial registration PROSPERO international prospective database of systematic reviews (CRD42021259238). Graphical abstracthttps://doi.org/10.1186/s13054-022-03896-3Omega-6 fatty acidFish oilOmega-3 fatty acidImmunonutritionCritical illnessParenteral nutrition |
| spellingShingle | Quirin Notz Zheng-Yii Lee Johannes Menger Gunnar Elke Aileen Hill Peter Kranke Daniel Roeder Christopher Lotz Patrick Meybohm Daren K. Heyland Christian Stoppe Omega-6 sparing effects of parenteral lipid emulsions—an updated systematic review and meta-analysis on clinical outcomes in critically ill patients Critical Care Omega-6 fatty acid Fish oil Omega-3 fatty acid Immunonutrition Critical illness Parenteral nutrition |
| title | Omega-6 sparing effects of parenteral lipid emulsions—an updated systematic review and meta-analysis on clinical outcomes in critically ill patients |
| title_full | Omega-6 sparing effects of parenteral lipid emulsions—an updated systematic review and meta-analysis on clinical outcomes in critically ill patients |
| title_fullStr | Omega-6 sparing effects of parenteral lipid emulsions—an updated systematic review and meta-analysis on clinical outcomes in critically ill patients |
| title_full_unstemmed | Omega-6 sparing effects of parenteral lipid emulsions—an updated systematic review and meta-analysis on clinical outcomes in critically ill patients |
| title_short | Omega-6 sparing effects of parenteral lipid emulsions—an updated systematic review and meta-analysis on clinical outcomes in critically ill patients |
| title_sort | omega 6 sparing effects of parenteral lipid emulsions an updated systematic review and meta analysis on clinical outcomes in critically ill patients |
| topic | Omega-6 fatty acid Fish oil Omega-3 fatty acid Immunonutrition Critical illness Parenteral nutrition |
| url | https://doi.org/10.1186/s13054-022-03896-3 |
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