Immunonutrition with eicosapentaenoic acid and γ-linolenic acid as a new strategy to reduce mortality and improve outcomes in patients with severe sepsis

Introduction

Enteral diets enriched with EPA (fish oil), GLA (borage oil) and elevated levels of antioxidant vitamins are capable of ameliorating several outcomes in patients with ARDS. Several studies using animal models of sepsis point towards a possible role of enteral nutrition enriched with omega-3 fatty acids in the reduction of mortality.

Hypothesis

This study investigates whether an enteral diet enriched with EPA, GLA and elevated levels of antioxidants can improve outcomes and reduce 28-day all-cause mortality in patients with severe sepsis or septic shock under mechanical ventilation.

Methods

This is a prospective, double-blind, placebo-controlled, randomized trial. One hundred and sixty-five patients with either severe sepsis or septic shock were enrolled. Patients were randomized and continuously tube-fed either EPA, GLA and elevated antioxidants or a control diet isonitrogenous and isocaloric to the study diet and delivered to achieve a minimum of 75% of basal energy expenditure × 1.3 during a minimum of 4 days.

Results

Septic patients fed EPA, GLA and elevated antioxidants showed a significant reduction in mortality rate, with an absolute reduction of 19.4% (P = 0.037). The EPA+GLA-fed group also presented significant improvements in oxygenation status from baseline to study days 4 and 7, more ventilator-free days (13.4 vs 5.8, P < 0.001), more ICU-free days (10.8 vs 4.6, P < 0.001) and significantly less development of new organ dysfunctions during the follow-up period (P < 0.001).

Conclusion

An enteral formulation enriched with EPA, GLA and elevated antioxidants can contribute to better ICU and hospital outcomes, and is also associated with lower mortality rates of septic patients under mechanical ventilation. The beneficial effects of this diet suggest that this enteral nutrition formula would be a useful adjuvant therapy in the clinical management of sepsis.