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Intravenous fish oil lipid emulsions in critically ill patients: an updated systematic review and meta-analysis.
Crit Care. 2015 Apr 16;19(1):167
Authors: Manzanares W, Langlois PL, Dhaliwal R, Lemieux M, Heyland DK
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 emulsions may be able to decrease mortality and ventilation days in the critically ill. Over the last year, several additional randomized controlled trials (RCTs) of FO containing emulsions have been published. Therefore, the purpose of this systematic review was to update our systematic review aimed to elucidate the efficacy of FO-containing emulsions on clinical outcomes in the critically ill.
METHODS: We searched computerized databases from 1980 to 2014. We included 4 new RCTs conducted in critically ill adult patients that evaluated FO containing emulsions in parenterally or enterally fed patients.
RESULTS: A total of 10 RCTs (n = 733) met inclusion criteria. The mean methodological score was 8 (range, 3-12). No effect on overall mortality was found. When the results of 5 RCTs that reported infections were aggregated, FO containing emulsions significantly reduced infections (RR 0.64; 95% CI, 0.44-0.92; P = 0.02, heterogeneity I (2) = 0%). Subgroup analysis demonstrated that predominantly enteral nutrition (EN) based trials showed a tendency towards a reduction in mortality (RR 0.69; 95% CI, 0.40-1.18, P = 0.18, heterogeneity I (2) = 35%). High quality trials showed a significant reduction in hospital length of stay (LOS) (WMD -7.42; 95% CI, -11.89, -2.94, P = 0.001) although low quality trials had no effect (P = 0.45); test for subgroup differences on hospital LOS was significant (P = 0.001).
CONCLUSION: FO containing emulsions may be associated with a reduction in infections, as well as could be associated with a reduction in duration of ventilation and hospital length of stay. Further large scale RCTs, which should aim to consolidate potential positive treatment effects, are warranted.
PMID: 25879776 [PubMed - as supplied by publisher]