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Published in: Critical Care 1/2022

Open Access 01-12-2022 | Nutrition | Research

Omega-6 sparing effects of parenteral lipid emulsions—an updated systematic review and meta-analysis on clinical outcomes in critically ill patients

Authors: Quirin Notz, Zheng-Yii Lee, Johannes Menger, Gunnar Elke, Aileen Hill, Peter Kranke, Daniel Roeder, Christopher Lotz, Patrick Meybohm, Daren K. Heyland, Christian Stoppe

Published in: Critical Care | Issue 1/2022

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Abstract

Background

Parenteral lipid emulsions in critical care are traditionally based on soybean oil (SO) and rich in pro-inflammatory omega-6 fatty acids (FAs). Parenteral nutrition (PN) strategies with the aim of reducing omega-6 FAs may potentially decrease the morbidity and mortality in critically ill patients.

Methods

A systematic search of MEDLINE, EMBASE, CINAHL and CENTRAL was conducted to identify all randomized controlled trials in critically ill patients published from inception to June 2021, which investigated clinical omega-6 sparing effects. Two independent reviewers extracted bias risk, treatment details, patient characteristics and clinical outcomes. Random effect meta-analysis was performed.

Results

1054 studies were identified in our electronic search, 136 trials were assessed for eligibility and 26 trials with 1733 critically ill patients were included. The median methodologic score was 9 out of 14 points (95% confidence interval [CI] 7, 10). Omega-6 FA sparing PN in comparison with traditional lipid emulsions did not decrease overall mortality (20 studies; risk ratio [RR] 0.91; 95% CI 0.76, 1.10; p = 0.34) but hospital length of stay was substantially reduced (6 studies; weighted mean difference [WMD] − 6.88; 95% CI − 11.27, − 2.49; p = 0.002). Among the different lipid emulsions, fish oil (FO) containing PN reduced the length of intensive care (8 studies; WMD − 3.53; 95% CI − 6.16, − 0.90; p = 0.009) and rate of infectious complications (4 studies; RR 0.65; 95% CI 0.44, 0.95; p = 0.03). When FO was administered as a stand-alone medication outside PN, potential mortality benefits were observed compared to standard care.

Conclusion

Overall, these findings highlight distinctive omega-6 sparing effects attributed to PN. Among the different lipid emulsions, FO in combination with PN or as a stand-alone treatment may have the greatest clinical impact.
Trial registration PROSPERO international prospective database of systematic reviews (CRD42021259238).

Graphical abstract

Appendix
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Metadata
Title
Omega-6 sparing effects of parenteral lipid emulsions—an updated systematic review and meta-analysis on clinical outcomes in critically ill patients
Authors
Quirin Notz
Zheng-Yii Lee
Johannes Menger
Gunnar Elke
Aileen Hill
Peter Kranke
Daniel Roeder
Christopher Lotz
Patrick Meybohm
Daren K. Heyland
Christian Stoppe
Publication date
01-12-2022
Publisher
BioMed Central
Keyword
Nutrition
Published in
Critical Care / Issue 1/2022
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-022-03896-3

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