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01-10-2013 | Systematic Review

Alternative lipid emulsions in the critically ill: a systematic review of the evidence

Authors: William Manzanares, Rupinder Dhaliwal, Brian Jurewitsch, Renee D. Stapleton, Khursheed N. Jeejeebhoy, Daren K. Heyland

Published in: Intensive Care Medicine | Issue 10/2013

Abstract

Purpose

Parenteral lipid emulsions (LEs) are commonly rich in long-chain triglycerides derived from soybean oil (SO). SO-containing emulsions may promote systemic inflammation and therefore may adversely affect clinical outcomes. We hypothesized that alternative oil-based LEs (SO-sparing strategies) may improve clinical outcomes in critically ill adult patients compared to products containing SO emulsion only. The purpose of this systematic review was to evaluate the effect of parenteral SO-sparing strategies on clinical outcomes in intensive care unit (ICU) patients.

Methods

We searched computerized databases from 1980 to 2013. We included randomized controlled trials (RCTs) conducted in critically ill adult patients that evaluated SO-sparing strategies versus SO-based LEs in the context of parenteral nutrition.

Results

A total of 12 RCTs met the inclusion criteria. When the results of these RCTs were statistically aggregated, SO-sparing strategies were associated with clinically important reductions in mortality (risk ratio, RR 0.83; 95 % confidence intervals, CI 0.62, 1.11; P = 0.20), in duration of ventilation (weighted mean difference, WMD −2.57; 95 % CI −5.51, 0.37; P = 0.09), and in ICU length of stay (LOS) (WMD −2.31; 95 % CI −5.28, 0.66; P = 0.13) but none of these differences were statistically significant. SO-sparing strategies had no effect on infectious complications (RR 1.13; 95 % CI 0.87, 1.46; P = 0.35).

Conclusion

Alternative oil-based LEs may be associated with clinically important reductions in mortality, duration of ventilation, and ICU LOS but lack of statistical precision precludes any clinical recommendations at this time. Further research is warranted to confirm these potential positive treatment effects.

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Title: Alternative lipid emulsions in the critically ill: a systematic review of the evidence
Authors: William Manzanares
Rupinder Dhaliwal
Brian Jurewitsch
Renee D. Stapleton
Khursheed N. Jeejeebhoy
Daren K. Heyland
Publication date: 01-10-2013
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 10/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-013-2999-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Alternative lipid emulsions in the critically ill: a systematic review of the evidence

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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