Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2010

Open Access 01-02-2010 | Research

Effects of a fish oil containing lipid emulsion on plasma phospholipid fatty acids, inflammatory markers, and clinical outcomes in septic patients: a randomized, controlled clinical trial

Authors: Vera M Barbosa, Elizabeth A Miles, Conceição Calhau, Estevão Lafuente, Philip C Calder

Published in: Critical Care | Issue 1/2010

Login to get access

Abstract

Introduction

The effect of parenteral fish oil in septic patients is not widely studied. This study investigated the effects of parenteral fish oil on plasma phospholipid fatty acids, inflammatory mediators, and clinical outcomes.

Methods

Twenty-five patients with systemic inflammatory response syndrome or sepsis, and predicted to need parenteral nutrition were randomized to receive either a 50:50 mixture of medium-chain fatty acids and soybean oil or a 50:40:10 mixture of medium-chain fatty acids, soybean oil and fish oil. Parenteral nutrition was administrated continuously for five days from admission. Cytokines and eicosanoids were measured in plasma and in lipopolysaccharide-stimulated whole blood culture supernatants. Fatty acids were measured in plasma phosphatidylcholine.

Results

Fish oil increased eicosapentaenoic acid in plasma phosphatidylcholine (P < 0.001). Plasma interleukin (IL)-6 concentration decreased significantly more, and IL-10 significantly less, in the fish oil group (both P < 0.001). At Day 6 the ratio PO2/FiO2 was significantly higher in the fish oil group (P = 0.047) and there were fewer patients with PO2/FiO2 <200 and <300 in the fish oil group (P = 0.001 and P = 0.015, respectively). Days of ventilation, length of intensive care unit (ICU) stay and mortality were not different between the two groups. The fish oil group tended to have a shorter length of hospital stay (22 ± 7 vs. 55 ± 16 days; P = 0.079) which became significant (28 ± 9 vs. 82 ± 19 days; P = 0.044) when only surviving patients were included.

Conclusions

Inclusion of fish oil in parenteral nutrition provided to septic ICU patients increases plasma eicosapentaenoic acid, modifies inflammatory cytokine concentrations and improves gas exchange. These changes are associated with a tendency towards shorter length of hospital stay.

Trials Registration

Clinical Trials Registration Number ISRCTN89432944
Appendix
Available only for authorised users
Literature
1.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992, 101: 1644-1655. 10.1378/chest.101.6.1644.CrossRefPubMed
2.
Warren HS: Strategies for the treatment of sepsis. N Engl J Med. 1997, 336: 952-953. 10.1056/NEJM199703273361311.CrossRefPubMed
3.
Martin GS, Mannino DM, Eaton S, Moss M: The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003, 348: 1546-1554. 10.1056/NEJMoa022139.CrossRefPubMed
4.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR: Epidemiology of severe sepsis in the United States: analysis of incidence, outcome and associated cost of case. Crit Care Med. 2001, 29: 1303-1310. 10.1097/00003246-200107000-00002.CrossRefPubMed
5.
Sands KE, Bates DW, Lanken PN, Graman PS, Hibberd PL, Kahn KL, Parsonnet J, Panzer R, Orav EJ, Snydman DR, Black E, Schwartz JS, Moore R, Johnson BL, Platt R, Academic Medical Center Consortium Sepsis Project Working Group: Epidemiology of sepsis syndrome in 8 academic medical centers. JAMA. 1997, 278: 234-240. 10.1001/jama.278.3.234.CrossRefPubMed
6.
Osuchowski MF, Welch K, Siddiqui J, Remick DG: Circulating cytokine/inhibitor profiles reshape the understanding of the SIRS/CARS continuum in sepsis and predict mortality. J Immunol. 2006, 177: 1967-1974.CrossRefPubMed
7.
Furst P, Kuhn KS: Fish oil emulsions: what benefits can they bring?. Clin Nutr. 2000, 19: 7-14. 10.1054/clnu.1999.0072.CrossRefPubMed
8.
Grimble R: Fatty acid profile of modern lipid emulsions: scientific considerations for creating the ideal composition. Clin Nutr Suppl. 2005, 1: 9-15. 10.1016/j.clnu.2005.05.009.CrossRef
9.
Calder PC: Use of fish oil in parenteral nutrition: rationale and reality. Proc Nutr Soc. 2006, 65: 264-277. 10.1079/PNS2006500.CrossRefPubMed
10.
Calder PC: Rationale for using new lipid emulsions in parenteral nutrition and a review of the trials performed in adults. Proc Nutr Soc. 2009, 68: 252-260. 10.1017/S0029665109001268.CrossRefPubMed
11.
Calder PC: N-3 polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am J Clin Nutr. 2006, 83: 1505S-1519S.PubMed
12.
Mascioli EA, Iwasa Y, Trimbo S, Leader L, Bistrian BR, Blackburn GL: Endotoxin challenge after menhaden oil diet: effects on survival of guinea pigs. Am J Clin Nutr. 1989, 49: 277-282.PubMed
13.
Sadeghi S, Wallace FA, Calder PC: Dietary lipids modify the cytokine response to bacterial lipopolysaccharide in mice. Immunology. 1999, 96: 404-410. 10.1046/j.1365-2567.1999.00701.x.PubMedCentralCrossRefPubMed
14.
Mascioli EA, Leader L, Flores E, Trimbo S, Bistrian B, Blackburn G: Enhanced survival to endotoxin in guinea pigs fed iv fish oil emulsion. Lipids. 1988, 23: 623-625. 10.1007/BF02535609.CrossRefPubMed
15.
Schauder P, Rohn U, Schafer G, Korff G, Schenk H-D: Impact of fish oil enriched total parenteral nutrition on DNA synthesis, cytokine release and receptor expression by lymphocytes in the postoperative period. Br J Nutr. 2002, 87: S103-S110. 10.1079/BJN2001463.CrossRefPubMed
16.
Weiss G, Meyer F, Matthies B, Pross M, Koenig W, Lippert H: Immunomodulation by perioperative administration of n-3 fatty acids. Br J Nutr. 2002, 87: S89-S94. 10.1079/BJN2001461.CrossRefPubMed
17.
Wachtler P, Konig W, Senkal M, Kemen M, Koller M: Influence of a total parenteral nutrition enriched with ω-3 fatty acids on leukotriene synthesis of peripheral leukocytes and systemic cytokine levels in patients with major surgery. J Trauma. 1997, 42: 191-198. 10.1097/00005373-199702000-00004.CrossRefPubMed
18.
Wichmann MW, Thul P, Czarnetzki HD, Morlion BJ, Kemen M, Jauch KW: Evaluation of clinical safety and beneficial effects of a fish oil containing lipid emulsion (Lipoplus, MLF541): data from a prospective, randomized, multicenter trial. Crit Care Med. 2007, 35: 700-706. 10.1097/01.CCM.0000257465.60287.AC.CrossRefPubMed
19.
Tappy L, Berger MM, Schwarz JM, Schneiter P, Kim S, Revelly JP, Chioléro R: Metabolic effects of parenteral nutrition enriched with n-3 polyunsaturated fatty acids in critically ill patients. Clin Nutr. 2006, 25: 588-595. 10.1016/j.clnu.2006.03.008.CrossRefPubMed
20.
Antebi H, Mansoor O, Ferrier C, Tetegan M, Morvan C, Rangaraj J, Alcindor LG: Liver function and plasma antioxcidant status in intensive care unit patients requiring total parenteral nutrition: comparison of 2 fat emulsions. JPEN J Parenter Enteral Nutr. 2004, 28: 142-148. 10.1177/0148607104028003142.CrossRefPubMed
21.
Mayer K, Fegbeutel C, Hattar K, Sibelius U, Krämer HJ, Heuer KU, Temmesfeld-Wollbrück B, Gokorsch S, Grimminger F, Seeger W: Omega-3 vs omega-6 lipid emulsions exert differential influence on neutrophils in septic shock: impact on plasma fatty acids and lipid mediator generation. Intensive Care Med. 2003, 29: 1472-1481. 10.1007/s00134-003-1900-2.CrossRefPubMed
22.
Mayer K, Gokorsch S, Fegbeutel C, Hattar K, Rosseau S, Walmrath D, Seeger W, Grimminger F: Parenteral nutrition with fish oil modulates cytokines response in patients with sepsis. Am J Resp Crit Care Med. 2003, 167: 1321-1328. 10.1164/rccm.200207-674OC.CrossRefPubMed
23.
Heller AR, Rossler S, Litz RJ, Stehr SN, Heller SC, Koch R, Koch T: Omega-3 fatty acids improve the diagnosis-related clinical outcome. Crit Care Med. 2006, 34: 972-979. 10.1097/01.CCM.0000206309.83570.45.CrossRefPubMed
24.
Friesecke S, Lotze C, Köhler J, Heinrich A, Felix SB, Abel P: Fish oil supplementation in the parenteral nutrition of critically ill medical patients: a randomised controlled trial. Intensive Care Med. 2008, 34: 1411-1420. 10.1007/s00134-008-1072-1.CrossRefPubMed
25.
Wang X, Li W, Li N, Li J: Omega Fatty Acids-Supplemented parenteral nutrition decreases hyperinflammatory response and attenuates systemic disease sequelae in severe acute pancreatitis: a randomized and controlled study. JPEN J Parent Ent Nutr. 2008, 32: 236-241. 10.1177/0148607108316189.CrossRef
26.
Gadek JE, DeMichele SJ, Karlstad MD: Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ARDS Study Group. Crit Care Med. 1999, 27: 1409-1420. 10.1097/00003246-199908000-00001.CrossRefPubMed
27.
Singer P, Theilla M, Fisher H, Gibstein L, Grozovski E, Cohen J: Benefit of an enteral diet enriched with eicosapentaenoic acid and gamma-linolenic acid in ventilated patients with acute lung injury. Crit Care Med. 2006, 34: 1033-1038. 10.1097/01.CCM.0000206111.23629.0A.CrossRefPubMed
28.
Pontes-Arruda A, Aragão AM, Albuquerque JD: Effects of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in mechanically ventilated patients with severe sepsis and septic shock. Crit Care Med. 2006, 34: 325-2333. 10.1097/01.CCM.0000234033.65657.B6.CrossRef
29.
Simoens CM, Deckelbaum RJ, Massaut JJ, Carpentier YA: Inclusion of 10% fish oil in mixed medium-chain triacylglycerol-long-chain triacylglycerol emulsions increases plasma triacylglycerol clearance and induces rapid eicosapentaenoic acid (20:5n-3) incorporation into blood cell phospholipids. Am J Clin Nutr. 2008, 88: 282-288.PubMed
30.
Harris JA, Benedict FG: Biometric Study of Basal Metabolism in Man. 1919, Washington DC: Carnegie Institute
31.
Yaqoob P, Pala HS, Cortina-Borja M, Newsholme EA, Calder PC: Encapsulated fish oil enriched in α-tocopherol alters plasma phospholipid and mononuclear cell fatty acid compositions but not mononuclear cell functions. Eur J Clin Invest. 2000, 30: 260-274. 10.1046/j.1365-2362.2000.00623.x.CrossRefPubMed
32.
Burdge GC, Wright P, Jones AE, Wootton SA: A method for separation of phosphatidylcholine, triacylglycerol, non-esterified fatty acids and cholesterol esters from plasma by solid-phase extraction. Br J Nutr. 2000, 84: 781-787.PubMed
33.
Conquer JA, Tierney MC, Zecevic J, Bettger WJ, Fisher RH: Fatty acid analysis of blood plasma of patients with Alzheimer's disease, other types of dementia, and cognitive impairment. Lipids. 2000, 35: 1305-1312. 10.1007/s11745-000-0646-3.CrossRefPubMed
34.
Köller M, Senkal M, Kemen M, König W, Zumtobel V, Muhr G: Impact of omega-3 fatty acid enriched TPN on leukotriene synthesis by leukocytes after major surgery. Clin Nutr. 2003, 22: 59-64. 10.1054/clnu.2002.0592.CrossRefPubMed
35.
Senkal M, Haaker R, Linseisen J, Wolfram G, Homann HH, Stehle P: Preoperative oral supplementation with long-chain Omega-3 fatty acids beneficially alters phospholipid fatty acid patterns in liver, gut mucosa, and tumor tissue. JPEN J Parent Ent Nutr. 2005, 29: 236-240. 10.1177/0148607105029004236.CrossRef
36.
Morlion BJ, Torwesten E, Lessire H, Sturm G, Peskar BM, Fürst P, Puchstein C: The effect of parenteral fish oil on leukocyte membrane fatty acid composition and leukotriene-synthesizing capacity in patients with postoperative trauma. Metabolism. 1996, 45: 1208-1213. 10.1016/S0026-0495(96)90237-1.CrossRefPubMed
37.
Tsekos E, Reuter C, Stehle P, Boeden G: Perioperative administration of parenteral fish oil supplements in a routine clinical setting improves patient outcome after major abdominal surgery. Clin Nutr. 2004, 23: 325-330. 10.1016/j.clnu.2003.07.008.CrossRefPubMed
38.
Meyer K, Kiessling A, Ott J, Schaefer MB, Hecker M, Henneke I, Schilz R, Gunther A, Wang J, Wu L, Roth J, Seeger W, Kang JX: Acute lung injury is reduced in fat-1 mice endogenously synthesizing n-3 fatty acids. Am J Resp Crit Care Med. 2009, 179: 474-483. 10.1164/rccm.200807-1064OC.CrossRef
39.
Kirchhoff C, Biberthaler P, Mutschler WE, Faist E, Jochum M, Zedler S: Early down-regulation of the pro-inflammatory potential of monocytes is correlated to organ dysfunction in patients after severe multiple injury: a prospective cohort study. Crit Care. 2009, 13: R88-10.1186/cc7914.PubMedCentralCrossRefPubMed
40.
Heidecke C-D, Weighardt H, Hensler T, Bartels H, Holzmann B: Immunparalyse von T-lymphocyten und monocyten in der postoperativen abdominellen sepsis. Chirurg. 2000, 71: 159-165. 10.1007/s001040050028.CrossRefPubMed
41.
Arnalich F, Garcia-Palomero E, Lopez J, Jimenez M, Madero R, Renart J, Vazquez JJ, Montiel C: Predictive value of nuclear factor κB activity and plasma cytokine levels in patients with sepsis. Infect Immun. 2000, 68: 1942-1945. 10.1128/IAI.68.4.1942-1945.2000.PubMedCentralCrossRefPubMed
42.
Bozza FA, Salluh JI, Japiassu AM, Soares M, Assis EF, Gomes RN, Bozza MT, Castro-Faria-Neto HC, Bozza PT: Cytokine profiles as markers of disease severity in sepsis: a multiplex analysis. Crit Care. 2007, 11: R49-10.1186/cc5783.PubMedCentralCrossRefPubMed
43.
Pinsky MR, Vincent JL, Deviere J, Alegre M, Kahn RJ, Dupont E: Serum cytokine levels in human septic shock. Relation to multiple-system organ failure and mortality. Chest. 1993, 103: 565-575. 10.1378/chest.103.2.565.CrossRefPubMed
44.
LaRue KE, McCall CE: A labile transcriptional repressor modulates endotoxin tolerance. J Exp Med. 1994, 180: 2269-2275. 10.1084/jem.180.6.2269.CrossRefPubMed
45.
Bohuslav J, Kravchenko VV, Parry GC, Erlich JH, Gerondakis S, Mackman N, Ulevitch RJ: Regulation of an essential innate immune response by the p50 subunit of NF-kappaB. J Clin Invest. 1998, 102: 1645-1652. 10.1172/JCI3877.PubMedCentralCrossRefPubMed
46.
Kohler NG, Joly A: The involvement of an LPS inducible I kappa B kinase in endotoxin tolerance. Biochem Biophys Res Commun. 1997, 232: 602-607. 10.1006/bbrc.1997.6337.CrossRefPubMed
47.
Calder PC: Polyunsaturated fatty acids and inflammatory processes: new twists in an old tale. Biochimie. 2009, 91: 791-795. 10.1016/j.biochi.2009.01.008.CrossRefPubMed
48.
Singer P, Shapiro H, Theilla M, Anbar R, Singer J, Cohen J: Anti-inflammatory properties of omega-3 fatty acids in critical illness: novel mechanisms and an integrated perspective. Intens Care Med. 2008, 34: 1580-159. 10.1007/s00134-008-1142-4.CrossRef
49.
Ariel A, Serhan CN: Resolvins and protectins in the termination program of acute inflammation. Trends Immunol. 2007, 28: 176-183. 10.1016/j.it.2007.02.007.CrossRefPubMed
Metadata
Title
Effects of a fish oil containing lipid emulsion on plasma phospholipid fatty acids, inflammatory markers, and clinical outcomes in septic patients: a randomized, controlled clinical trial
Authors
Vera M Barbosa
Elizabeth A Miles
Conceição Calhau
Estevão Lafuente
Philip C Calder
Publication date
01-02-2010
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2010
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc8844

Other articles of this Issue 1/2010

Critical Care 1/2010 Go to the issue

Meeting report

Highlights from the Critical Care Canada Forum 2009 - 25 to 28 October 2009, Toronto, Ontario, Canada

Research

Insulin-treated diabetes is not associated with increased mortality in critically ill patients

Commentary

Burns: learning from the past in order to be fit for the future

Research

Mild hypothermia alone or in combination with anesthetic post-conditioning reduces expression of inflammatory cytokines in the cerebral cortex of pigs after cardiopulmonary resuscitation

Commentary

Arterial pressure optimization in the treatment of septic shock: a complex puzzle

Letter

Value and price of ventilator-associated pneumonia surveillance as a quality indicator