Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Influence of n-3 Polyunsaturated Fatty Acids Enriched Lipid Emulsions on Nosocomial Infections and Clinical Outcomes in Critically Ill Patients

ICU Lipids Study*

Grau-Carmona, Teodoro MD, PhD1; Bonet-Saris, Alfonso MD2; García-de-Lorenzo, Abelardo MD, PhD3; Sánchez-Alvarez, Carmen MD, PhD4; Rodríguez-Pozo, Angel MD, PhD5; Acosta-Escribano, José MD6; Miñambres, Eduardo MD, PhD7; Herrero-Meseguer, Jose Ignacio MD8; Mesejo, Alfonso MD9

doi: 10.1097/CCM.0000000000000612
Feature Articles
Buy
SDC

Objective: n-3 polyunsaturated fatty acids (contained in fish oil) have been shown to beneficially influence infection rate and clinical outcomes in surgical patients probably due to their immunomodulatory action. In contrast, study results of fish oil administration in critically ill patients are controversial. The aim of this study was to investigate the effects of n-3 polyunsaturated fatty acids on the prevalence of nosocomial infections and clinical outcomes in medical and surgical critically ill patients.

Design: Prospective, multicenter, randomized, comparative, double-blind study.

Setting: Seventeen Spanish ICUs during 4 years.

Subjects: A total of 159 medical and surgical intensive care patients with Acute Physiology and Chronic Health Evaluation II score more than or equal to 13, expected to require total parenteral nutrition for at least 5 days.

Interventions: Patients received total parenteral nutrition prepared either with a lipid emulsion containing 10% fish oil or a fish oil–free lipid emulsion. The prevalence of nosocomial infections was detected during 28 days of ICU stay. Patients were followed 6 months after discharge from the ICU for length of hospital stay, hospital mortality, and 6-month mortality.

Measurements and Main Results: The number of patients with nosocomial infections was significantly reduced in the fish oil–receiving group (21.0% vs 37.2%, p = 0.035) and the predicted time free of infection was prolonged (21 ± 2 vs 16 ± 2 d, p = 0.03). No significant differences were detected for ICU, hospital, and 6-month mortality.

Conclusions: The results show that administration of n-3 polyunsaturated fatty acids reduces the risk of nosocomial infections and increases the predicted time free of infections in critically ill medical and surgical patients. The administration of n-3 polyunsaturated fatty acids was safe and well tolerated.

1Intensive Care Unit, Hospital Universitario Doce de Octubre, Madrid, Spain.

2Intensive Care Unit, Clinica Girona, Girona, Spain.

3Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain.

4Intensive Care Unit, Hospital General Universitario Reina Sofía, Murcia, Spain.

5Intensive Care Unit, Hospital Universitari Arnau de Vilanova, Lleida, Spain.

6Intensive Care Unit, Hospital General Universitario de Alicante, Alicante, Spain

7Intensive Care Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain.

8Intensive Care Unit, Hospital Universitario de Bellvitge, Barcelona, Spain.

9Intensive Care Unit, Hospital Clinico Universitario, Valencia, Spain.

* See also p. 230.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

ICU Lipids was sponsored by BBraun Medical S.A., Spain.

Dr. Grau-Carmon received support for travel from BBraun Medical S.A. and lectured for Fresenius Kabi S.A. and Orion Pharma S.A. Dr. Bonet-Saris received support for travel from BBraun Medical. He and his institution received grant support from BBraun Medical. Dr. Garcia-de-Lorenzo received support for travel. Dr. Sanchez-Alvarez received support for travel from BBraun Medical. He and his institution received grant support from BBraun Medical. Dr. Rodriguez-Pozo has disclosed work for hire. His institution received grant support from BBraun Medical S.A. Dr. Acosta-Escribano received support for travel from BBraun Medical S.A. and has disclosed work for hire. He and his institution received grant support from BBraun Medical S.A. Dr. Miñambres has disclosed work for hire. He and his institution received grant support from BBraun Medical S.A. Dr. Herrero-Meseguer served as a consultant. Dr. Mesejo received support for travel from BBraun Medical S.A. and disclosed work for hire. He and his institution received grant support from BBraun Medical S.A.

For information regarding this article, E-mail: teodoro.grau@salud.madrid.org

© 2015 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins