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The Role of Ω-3 Fatty Acid Supplemented Parenteral Nutrition in Critical Illness in Adults: A Systematic Review and Meta-Analysis
The Role of Ω-3 Fatty Acid Supplemented Parenteral Nutrition in Critical Illness in Adults: A Systematic Review and Meta-Analysis. Palmer AJ, Ho CK, Ajibola O, et al. Crit Care Med. 2013;41. (E-pub ahead of print.)
Study Question: Does supplementation of parenteral nutrition (PN) with ω-3 fatty acids (FA) confer treatment benefits to critically ill adult patients?
Study Description: This meta-analysis was conducted using computerized searches for articles from 1996 to June 2011 on MEDLINE, EMBASE, and the Cochrane register of controlled trials, as well as abstract proceedings. Studies were included if they were randomized controlled trials (RCTs) in critically ill adults admitted to an intensive therapy unit (ITU) comparing ω-3 FA supplemented PN with standard-care PN containing another lipid. Primary outcome
data included mortality, hospital length of stay (LOS), and ITU LOS. Secondary outcome data included new infections, length of mechanical ventilation, adverse events, quality of life, and economic outcomes.
Results: Five published trials and three trials published in abstract form with 391 participants were included. All were single centered trials. Most participants were admitted with sepsis, trauma, abdominal sepsis, and severe acute pancreatitis and received PN was between 5 and 10 days. The dose of ω-3 FA provided to the intervention group varied from 0.08 g/kg/d to 0.2 g/kg/d. Mortality was not different for patients receiving ω-3 FA-supplemented PN (RR 0.83, 95% CI 0.57-1.20, p = 0.32; I2 = 0%, I2 p = 0.96). In meta-analysis of five studies with 337 participants, there was no difference in the frequency of new infections (RR 0.78; 95% CI 0.43, 1.41; p = 0.41; I2 = 51%, I2 p = 0.09). Six studies with 305 participants were analyzed for ITU LOS and there was no difference between the intervention and control groups (-0.57 days; 95% CI -5.05, 3.90; p = 0.80; I2 = 49%, I2 p = 0.08). Three studies with 117 patients were assessed for hospital LOS and showed a significant reduction of 9.49 days in patients receiving ω-3 FA (95% CI -16.51, 2.47; p < 0.01), but this was strongly influenced by one study. No study found a significant difference in length of mechanical ventilation except one favoring the intervention group (p < 0.01).
Conclusion(s): There is insufficient evidence to recommend the supplementation of PN with ω-3 FA in critically ill adult patients.
Perspective: Supplementation of PN with ω-3 FA remains to be a theoretical benefit in patients with SIRS. The results of this meta-analysis must be interpreted cautiously due to the poor methodological quality of the trials, overall small number of studies assessing ω-3 FA supplemented PN, and limited clinical meaningful outcome data. Larger, well-designed RCTs to identify the patient population, dose of ω-3 FA, and timing of initiation of ω-3 FA are needed