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Table 1 Randomized clinical trials evaluating parenteral fish oil–containing lipid emulsions in critically ill patients a

From: Intravenous fish oil lipid emulsions in critically ill patients: an updated systematic review and meta-analysis

Study Population Methods (score) Intervention Mortality (%) b Infections (%) c
FO
Grecu et al ., 2003 d [62] Patients with abdominal sepsis C.Random: Yes PN + Omegaven (10% FO; Fresenius Kabi, Bad Homburg, Germany) plus LCT vs. PN with LCT Omegaven + LCT LCT Omegaven LCT
N =54 ITT: Yes ICU ICU VAP VAP
(15 of 54 in ICU) Blinding: Double 2/28 (7) 3/26 (12) 0/8 1/7 (14)
(12)
Friesecke et al ., 2008 [63] Medical ICU patients C.Random: Yes PN + Lipofundin (B Braun, Melsungen, Germany) MCT (50% LCT + 50% MCT) + Omegaven (10% FO) vs. PN with Lipofundin MCT (50% LCT + 50% MCT) MCT + LCT + FO LCT + MCT MCT + LCT + FO LCT + MCT
N =166 ITT: Yes 28 days 28 days 10/83 (12) 11/82 (13)
Blinding: Double 18/83 (22) 22/82 (27)
(10)
Wang et al ., 2009 [61] Severe acute pancreatitis patients in ICU C.Random: No PN + Omegaven (10% FO) plus Lipovenos (LCT, soybean oil; Fresenius Kabi) (ω3:ω6 ratio was 1:4) vs. PN with Lipovenos (LCT, soybean oil). Both received same amounts of lipids (1 g/kg/day) Omegaven LCT Omegaven LCT
N =56 ITT: Yes ICU ICU 6/28 (21) 9/28 (32)
Blinding: Double 0/28 (0) 2/28 (7)
(11)
Barbosa et al ., 2010 [64] ICU patients with SIRS or sepsis requiring PN C.Random: Yes PN + Lipolus (50% MCT, 40% LCT soybean oil, 10% FO; B Braun) vs. PN with NuTRIflex Lipid Special (50% MCT, 50% LCT, soybean oil; B Braun). Both received same amounts of lipids (about 1 g/kg/day) MCT + LCT + FO MCT + LCT MCT + LCT + FO MCT + LCT
N =25 ITT: Yes 5 days 5 days NR NR
Blinding: Single 2/13 (15) 1/10 (10)
(10) 28 days 28 days
4/13 (31) 4/10 (40)
Gupta et al ., 2011 [15] ICU patients with suspected ARDS C.Random: Yes EN (standard diet) + Omegaven 10% (ω3:ω6 ratio was 1:4) vs. EN (standard diet) Omegaven Standard NR NR
N =61 ITT: Yes ICU EN
Blinding: Double 7/31 (23) ICU
(9) Hospital 13/30 (43)
9/31 (29) Hospital
14/30 (47)
Khor et al ., 2011 [16] ICU patients with severe sepsis/septic shock C.Random: Yes Supplementation with 100 ml of 10% Omegaven (10 g of refined FO, EPA 12.5 to 28.2 g/L, DHA 14.4 to 30.9 g/L) vs. 100 ml of 0.9% normal saline NR NR NR NR
N =28 ITT: No
Blinding: Double
(8)
Burkhart et al ., 2013 [18] ICU patients with sepsis C.Random: ? 2 ml/kg/day Omegaven vs. no parenteral FO. Both groups received EN and/or PN without added FO at the discretion of the clinician. Omegaven No Omegaven NR NR
N =50 ITT: Yes Hospital Hospital
Blinding: Single (assessor) 13/25 (52) 13/25 (52)
(8)
Grau-Carmona et al ., 2014 [65] Medical and surgical patients requiring PN C.Random: Yes PN + Lipoplus (50% MCT, 40% LCT soybean oil, 10% FO; B Braun) vs. PN + Lipofundin (50% LCT + 50% MCT) MCT + LCT + FO MCT + LCT ICU MCT + LCT + FO MCT + LCT
N =175 ITT: Yes ICU 16/78 (20.5) 17/81 (21) 29/78 (37.2)
Blinding: Double 26/81 (32.5) Hospital
(10) Hospital 6/78 (9.7)
6/81 (11.1) 6 months
6 months 2/78 (3.6)
2/81 (4.3)
Gultekin et al ., 2014 [66] ICU patients needing TPN C.Random: ? PN + Omegaven (10% FO) plus ClinOleic (80% olive oil, 20% soybean oil; Baxter Healthcare, Compton, UK) vs. PN + ClinOleic Omegaven + olive oil Olive oil NR NR
N =58 ITT: Other Unspecified Unspecified
Blinding: Double 8/16 (50) 7/16 (44)
(3)
Hall et al ., 2014 [17] ICU patients with sepsis C.Random: ? Omegaven dosed at 0.2 g of FO/kg/day given at a rate of 0.05 g of FO/kg/day vs. no FO. Both groups received EN and/or PN at the discretion of the clinician. Omegaven No Omegaven Omegaven No Omegaven
N =60 ITT: Yes Hospital Hospital 3/30 (10) 5/30 (16.7)
Blinding: No 4/30 (13.3) 9/30 (30)
(9) 28 days 28 days
4/30 (13.3) 8/30 (26.7)
  1. aThese studies compared fish oil (ω-3)–containing emulsions in parenteral nutrition–fed patients with long-chain triglycerides or long-chain triglycerides + medium-chain triglycerides. ARDS, Acute respiratory distress syndrome; C.Random, Concealed randomization; DHA, Docosahexaenoic acid; EPA, Eicosapentaenoic acid; FO, Fish oil; ICU, Intensive care unit; ITT, Intention to treat; LCT, Long-chain triglycerides; LE, Lipid emulsion; MCT, Medium-chain triglycerides; NA, Non-attributable; NR, Non-reported; PN, Parenteral nutrition; SIRS, Systemic inflammatory response syndrome; TPN, Total parenteral nutrition; VAP, Ventilator-associated pneumonia; ?, Doubtful. bHospital mortality unless specified. cNumber of patients with infections unless specified. dData obtained from author, 8 out of 28 in Omegaven (Fresenius Kabi, Bad Homburg, Germany) and 7 of 26 in LCT group were in ICU.