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

Introduction

Nutritional support with diets containing eicosa-pentaenoic acid (EPA), gamma-linolenic acid (GLA) and anti-oxidants 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 diet can improve gas exchange and clinical outcomes in comparison with a standard control diet in patients with ARDS [2]. This study investigates whether an EPA + GLA + antioxidant enriched enteral diet can improve outcomes and reduce mortality in patients with sepsis.

Materials and methods

This are 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 enrolled in this study and were randomized for a high-fat, low-carbohydrate enteral nutrition formula or an enteral diet enriched with EPA + LGA + antioxidants (Oxepa; Abbott Laboratories). In association with sepsis standards of care, patients received enteral formula during mechanical ventilation. In all patients included in this study, 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 tolerated, a minimum of 75% of BEE × 1.3 within 72 hours of initiation of enteral feeding until complete weaning from the ventilator.

Results

Septic patients fed EPA + GLA + 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).

Conclusion

This study suggests that an enteral diet containing EPA, GLA and elevated antioxidants helps to downregulate the synthesis of proinflammatory mediators and contributes to restore homeostasis of the septic patient. The beneficial effects of this diet suggest that this enteral nutrition formula would be a useful adjuvant therapy in the clinical management of sepsis.