The effects of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid and antioxidants in patients with sepsis

Introduction

Nutritional support with diets containing eicosapentaenoic acid (EPA), gamma-linolenic acid (GLA) and antioxidants can improve lung microvascular permeability, oxygenation and cardiopulmonary function, by modulating proinflammatory eicosanoid (leukotriene B₄, prostaglandin E, thromboxane B₂) production from arachdonic acid [1]. This kind of enteral diet can improve gas exchange and clinical outcomes in comparison with a standard control diet in patients with ARDS [2]. The scope of this study is to investigate whether an enteral diet enriched with EPA, GLA and elevated antioxidants can improve outcomes and reduce all-cause mortality in patients with sepsis.

Materials and methods

This abstract reports the preliminary results of a prospective, randomized, controlled trial. Thirty patients with clinical diagnosis of either sepsis, severe sepsis or septic shock, and under mechanical ventilation were included in this work and randomized for a high-fat, low-carbohydrate enteral nutrition formula or an enteral diet enriched with EPA, GLA and elevated antioxidants (Oxepa; Abbott Laboratories), isocaloric and isonitrogenous to the control diet, differing only in its lipid composition and level of antioxidant vitamins. The patients received the enteral formula during mechanical ventilation in association with the sepsis standard of care [3]. Enteral feeding was delivered at a constant rate to achieve a minimum of 50% of Basal Energy Expenditure (BEE) (Harris–Benedict equation) × 1.3 within the first 24 hours and, if well tolerated, a minimum of 75% of BEE × 1.3 within 72 hours of initiation of enteral feeding, until the complete weaning from ventilator. At the time of hospital discharge, the patients' charts were reviewed to assess a number of outcome variables. The primary outcome is 28-day all-cause mortality. We perform the statistical analysis of the two dietary groups using a one-way analysis of variance.

Results

Septic patients fed EPA, GLA and elevated antioxidants maintained higher oxygenation status (P = 0.001), more ventilator-free days (P = 0.001), more ICU-free days (P = 0.02) and lower mortality rates (P = 0.03).

Conclusions

This study suggests that an enteral diet containing EPA, GLA and elevated antioxidants can contribute to better ICU and hospital outcomes of septic patients. This can be through a downregulation on the synthesis of proinflammatory mediators that contributes to restoring homeostasis of the septic patients. The beneficial effects of this diet suggest that this enteral nutrition formula would be a useful adjuvant therapy in the clinical management of sepsis.