Citation Information :
Patel S, Gupta A, Bhatnagar S, Goyal J, Baweja H. Efficacy and safety of parenteral omega 3 fatty acids in ventilated patients with acute lung injury. Indian J Crit Care Med 2011; 15 (2):108-113.
Objective: To determine the effects of parenteral omega 3 fatty acids (10% fatty acids) on respiratory parameters and outcome in ventilated patients with acute lung injury. Measurements and Main Results: Patients were randomized into two groups - one receiving standard isonitrogenous isocaloric enteral diet and the second receiving standard diet supplemented with parenteral omega 3 fatty acids (Omegaven, Fresenius Kabi) for 14 days. Patients demographics, APACHE IV, Nutritional assessment and admission category was noted at the time of admission. No significant difference was found in nutritional variables (BMI, Albumin). Compared with baseline PaO 2 /FiO 2 ratio (control vs. drug group: 199 ± 124 vs. 145 ± 100; P = 0.06), by days 4, 7, and 14, patients receiving the drug did not show a significant improvement in oxygenation (PaO 2 /FiO 2: 151.83 ± 80.19 vs. 177.19 ± 94.05; P = 0.26, 145.20 ± 109.5 vs. 159.48 ± 109.89; P = 0.61 and 95.97 ± 141.72 vs. 128.97 ± 140.35; P = 0.36). However, the change in oxygenation from baseline to day 14 was significantly better in the intervention as compared to control group (145/129 vs. 199/95; P < 0.0004). There was no significant difference in the length of ventilation (LOV) and length of ICU stay (LOS). There was no difference in survival at 28 days. Also, there was no significant difference in the length of ventilation and ICU stay in the survivors group as compared to the non survivors group. Conclusions: In ventilated patients with acute respiratory distress syndrome, intravenous Omega 3 fatty acids alone do not improve ventilation, length of ICU stay, or survival.
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342:1301-8.
Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 2004;351:327-36.
Halliwell B, Chiricos S. Lipid peroxidation: Its mechanism, measurement and significance. Am J Clin Nutr 1993;57(5 Suppl):715S-24S.
Calder PC. Long-chain n-3 fatty acids and inflammation: Potential application in surgical and trauma patients. Braz J Med Biol Res 2003; 36:433-46.
Gadek JE, DeMichele SJ, Karlstad MD, Pacht ER, Donahoe M, Albertson TE, et al. Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome: Enteral Nutrition in ARDS Study Group. Crit Care Med 1999;27:1409-20.
Singer P, Theilla M, Fisher H, Gibstein L, Grozovski E, Cohen J. Benefit of an enteral diet enriched with eicosapentaenoic acid and gamma-linolenic in ventilated patients with acute lung injury. Crit Care Med 2006;34:1033-8.
Mathru M, Dries DJ, Zecca A, Fareed J, Rooney MW, Rao TL. Effect of fast vs slow intralipid infusion on gas exchange, pulmonary hemodynamics, and prostaglandin metabolism. Chest 1991;99:426-9.
Hwang TL, Huang SL, Chen MF. Effects of intravenous fat emulsion on respiratory failure. Chest 1990;97:934-8.
Beale RJ, Bryg DJ, Bihari DJ. Immunonutrition in the critically ill: A systematic review of clinical outcome. Crit Care Med 1999;27:2799-805.
Sabater J, Masclans JR, Sacanell J, Chacon P, Sabin P, Planas M. Effects on hemodynamics and gas exchange of omega-3 fatty acid-enriched lipid emulsion in acute respiratory distress syndrome (ARDS): A prospective, randomized, double-blind, parallel group study. Lipids Health Dis 2008;7:39.
Friesecke S, Lotze C, Köhler J, Heinrich A, Felix SB, Abel P. Fish oil supplementation in the parenteral nutrition of critically ill medical patients: A randomized controlled trial. Intensive Care Medicine 2008;34:1411-20.
Faucher M, Bregeon F, Gainnier M, Thirion X, Auffray JP, Papazian L. Cardiopulmonary effects of Lipid Emulsions in Patients with ARDS. Chest 2003;124: 285-91.
Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS: Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149:818-24.
Wendel M, Paul R, Heller AR. Lipoproteins in inflammation and sepsis. II: Clinical aspects. Intensive Care Med 2007;33:25-35.
Mayer K, Schaefer MB, Seeger W. Fish oil in the critically ill: From experimental to clinical data. Curr Opin Clin Nutr Metab Care 2006;9:140-8.
Wichmann MW, Thul P, Czarnetzki HD, Morlion BJ, Kemen M, Jauch KW. Evaluation of clinical safety and beneficial effects of fish oil containing lipid emulsion (Lipoplus, MLF541): Data from a prospective, randomized, multicenter trial. Crit Care Med 2007;35:700-6.
Heller AR, Rossler S, Litz RJ, Stehr SN, Heller SC, Koch R, et al. Omega-3 fatty acids improve the diagnosis-related clinical outcome. Crit Care Med 2006;34:972-9.
Berger MM, Chiolero RL, Tappy L, Revelly JP, Geppert J, Franke C, et al. Safety of fish oil containing parenteral nutrition after abdominal aorta aneurysm surgery. Intensive Care Med 2005;31:S32.
Tsekos E, Reuter C, Stehle P, Boeden G. Perioperative administration of parenteral fish oil supplements in a routine clinical setting improves patient outcome after major abdominal surgery. Clin Nutr 2004;23:325-30.
Mayer K, Fegbeutel C, Hattar K, Sibelius U, Kramer HJ, Heuer KU, et al. Omega-3 vs. omega-6 lipid emulsions exert differential influence on neutrophils in septic shock patients: Impact on plasma fatty acids and lipid mediator generation. Intensive Care Med 2003;29:1472-81.
Matsuyama W, Mitsuyama H, Watanabe M, Oonakahara K, Higashimoto I, Osame M, et al. Effects of Omega - 3 polyunsaturated fatty acids in COAD. Chest 2005;128:3817-27.
Wendel M. Impact of TPN including omega 3 fatty acids after major surgery. e-SPEN 2007;2:e103-1