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The Effects of Different IV Fat Emulsions on Clinical Outcomes in Critically Ill Patients*

Edmunds, Christina E. MSc, RD, CNSC1,2; Brody, Rebecca A. PhD, RD, LD, CNSC2; Parrott, J. Scott PhD2; Stankorb, Susan M. DCN, RD, CNSC2; Heyland, Daren K. MD, FRCPC, MSc3,4

doi: 10.1097/CCM.0000000000000146
Clinical Investigations

Objective: To examine the effects of different IV fat emulsions on clinical outcomes in critically ill patients.

Design: Secondary analysis of data from a prospective multicenter study.

Setting: An international sample of ICUs.

Patients: Adult patients who were admitted to the ICU for more than 72 hours, were mechanically ventilated within 48 hours, received exclusive parenteral nutrition for more than or equal to 5 days, and did not change IV fat emulsion type during the data collection period.

Interventions: Demographic and clinical data were collected for up to 12 days, until death, or discharge from the ICU, whichever came first. Clinical outcomes were recorded at 60 days following ICU admission.

Measurements: Lipid-free, soybean, medium-chain triglyceride, olive, and fish oils in parenteral nutrition were compared using an adjusted Cox proportional hazard model to examine time to termination of mechanical ventilation alive, time to ICU discharge alive, and time to hospital discharge alive.

Main Results: A total of 451 patients were included in this study: 70 (15.5%) in the lipid-free group, 223 (49.5%) in the soybean oil group, 65 (14.4%) in the medium-chain triglyceride group, 74 (16.4%) in the olive oil group, and 19 (4.9%) in the fish oil group. When compared with lipid-free parenteral nutrition, patients who received fish oil had a faster time to ICU discharge alive (hazard ratio, 1.84; 95% CI, 1.01–3.34; p = 0.05). When compared with soybean oil, patients who received olive oil or fish oil had a shorter time to termination of mechanical ventilation alive (hazard ratio, 1.43; 95% CI, 1.06–1.93; p = 0.02 and hazard ratio, 1.67; 95% CI, 1.00–2.81; p = 0.05, respectively) and a shorter time to ICU discharge alive (hazard ratio, 1.76; 95% CI, 1.30–2.39; p < 0.001 and hazard ratio, 2.40; 95% CI, 1.43–4.03; p = 0.001, respectively).

Conclusions: Use of alternative IV fat emulsions in parenteral nutrition, particularly olive and fish oil, was associated with improved clinical outcomes.

1Food and Nutrition Services Department, Fraser Health Authority, Burnaby, BC, Canada.

2Department of Nutritional Sciences, School of Health Related Professions, Rutgers, The State University of New Jersey, Newark, NJ.

3Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada.

4Department of Medicine, Queen’s University, Kingston, ON, Canada.

* See also p. 1306.

This study was conducted at the Department of Nutritional Sciences, School of Health Related Professions, Rutgers, The State University of New Jersey. Original study conducted by the Clinical Evaluation Research Unit, Kingston General Hospital, ON, Canada.

Dr. Brody received support for manuscript preparation from the Academy of Nutrition and Dietetics (consultant to author a manuscript on advanced-level dietetics practice), support for the development of educational presentations from Dannemiller (educational webinar on dysphagia), and support for travel from the Commission on Dietetic Registration (travel to taskforce meetings). Her institution received grant support from the Academy of Nutrition and Dietetics Foundation—Colgate Palmolive (grant funding to provide educational research in Israel) and the Rutgers University Foundation (funding to support research on advanced level dietetics practice). Dr. Heyland consulted for Fresenius Kabi (lectured on the subject of glutamine and antioxidants), Biosyn (lectured on the subject of antioxidants), and GlaxoSmithKline (assisted in development of clinical program of research related to development of novel motilin agonist to improve gastric emptying and nutritional adequacy in critically ill patients); received support for travel from Fresenius Kabi; lectured for Nestle and Abbott Nutrition; and received support for development of educational presentations from Nestle. His institution received grant support from Fresenius Kabi (support for pilot study of this trial and all study products), Canadian Institutes of Health Research (support for this study), Nestle, and Abbott Nutrition. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: dkh2@queensu.ca

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins