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

Manzanares, William; Langlois, Pascal L; Dhaliwal, Rupinder; Lemieux, Margot; Heyland, Daren K

doi:10.1186/s13054-015-0888-7

Critical Care

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)
	(15 of 54 in ICU)	(12)		2/28 (7)	3/26 (12)	0/8	1/7 (14)
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)		18/83 (22)	22/82 (27)
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)		0/28 (0)	2/28 (7)
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
		(10)		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
				9/31 (29)	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)		13/25 (52)	13/25 (52)
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)	2/78 (3.6)
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)		8/16 (50)	7/16 (44)
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
		(9)		4/30 (13.3)	8/30 (26.7)

^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.

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