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Omega-6 sparing effects of parenteral lipid emulsions-an updated systematic review and meta-analysis on clinical outcomes in critically ill patients

Background: Parenteral lipid emulsions in critical care are traditionally based on soybean oil (SO) and rich in pro-inflammatory omega-6 fatty acids (FAs). Parenteral nutrition (PN) strategies with the aim of reducing omega-6 FAs may potentially decrease the morbidity and mortality in critically ill...

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Main Authors: Notz, Quirin, Lee, Zheng-Yii, Menger, Johannes, Elke, Gunnar, Hill, Aileen, Kranke, Peter, Roeder, Daniel, Lotz, Christopher, Meybohm, Patrick, Heyland, Daren K., Stoppe, Christian
Format: Article
Published: BioMed Central 2022
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R Medicine
RC Internal medicine
Online Access:http://eprints.um.edu.my/33474/
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spelling my.um.eprints.334742022-08-01T02:52:45Z http://eprints.um.edu.my/33474/ Omega-6 sparing effects of parenteral lipid emulsions-an updated systematic review and meta-analysis on clinical outcomes in critically ill patients Notz, Quirin Lee, Zheng-Yii Menger, Johannes Elke, Gunnar Hill, Aileen Kranke, Peter Roeder, Daniel Lotz, Christopher Meybohm, Patrick Heyland, Daren K. Stoppe, Christian R Medicine RC Internal medicine Background: Parenteral lipid emulsions in critical care are traditionally based on soybean oil (SO) and rich in pro-inflammatory omega-6 fatty acids (FAs). Parenteral nutrition (PN) strategies with the aim of reducing omega-6 FAs may potentially decrease the morbidity and mortality in critically ill patients. Methods: A systematic search of MEDLINE, EMBASE, CINAHL and CENTRAL was conducted to identify all randomized controlled trials in critically ill patients published from inception to June 2021, which investigated clinical omega-6 sparing effects. Two independent reviewers extracted bias risk, treatment details, patient characteristics and clinical outcomes. Random effect meta-analysis was performed. Results: 1054 studies were identified in our electronic search, 136 trials were assessed for eligibility and 26 trials with 1733 critically ill patients were included. The median methodologic score was 9 out of 14 points (95% confidence interval CI] 7, 10). Omega-6 FA sparing PN in comparison with traditional lipid emulsions did not decrease overall mortality (20 studies; risk ratio RR] 0.91; 95% CI 0.76, 1.10; p= 0.34) but hospital length of stay was substantially reduced (6 studies; weighted mean difference WMD] - 6.88; 95% CI - 11.27, - 2.49; p= 0.002). Among the different lipid emulsions, fish oil (FO) containing PN reduced the length of intensive care (8 studies; WMD -3.53; 95% CI - 6.16, - 0.90; p= 0.009) and rate of infectious complications (4 studies; RR 0.65; 95% CI 0.44, 0.95; p= 0.03). When FO was administered as a stand-alone medication outside PN, potential mortality benefits were observed compared to standard care. Conclusion: Overall, these findings highlight distinctive omega-6 sparing effects attributed to PN. Among the different lipid emulsions, FO in combination with PN or as a stand-alone treatment may have the greatest clinical impact. BioMed Central 2022-01-19 Article PeerReviewed Notz, Quirin and Lee, Zheng-Yii and Menger, Johannes and Elke, Gunnar and Hill, Aileen and Kranke, Peter and Roeder, Daniel and Lotz, Christopher and Meybohm, Patrick and Heyland, Daren K. and Stoppe, Christian (2022) Omega-6 sparing effects of parenteral lipid emulsions-an updated systematic review and meta-analysis on clinical outcomes in critically ill patients. Critical Care, 26 (1). ISSN 1364-8535, DOI https://doi.org/10.1186/s13054-022-03896-3 <https://doi.org/10.1186/s13054-022-03896-3>. (In Press) 10.1186/s13054-022-03896-3
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic R Medicine
RC Internal medicine
spellingShingle R Medicine
RC Internal medicine
Notz, Quirin
Lee, Zheng-Yii
Menger, Johannes
Elke, Gunnar
Hill, Aileen
Kranke, Peter
Roeder, Daniel
Lotz, Christopher
Meybohm, Patrick
Heyland, Daren K.
Stoppe, Christian
Omega-6 sparing effects of parenteral lipid emulsions-an updated systematic review and meta-analysis on clinical outcomes in critically ill patients
description Background: Parenteral lipid emulsions in critical care are traditionally based on soybean oil (SO) and rich in pro-inflammatory omega-6 fatty acids (FAs). Parenteral nutrition (PN) strategies with the aim of reducing omega-6 FAs may potentially decrease the morbidity and mortality in critically ill patients. Methods: A systematic search of MEDLINE, EMBASE, CINAHL and CENTRAL was conducted to identify all randomized controlled trials in critically ill patients published from inception to June 2021, which investigated clinical omega-6 sparing effects. Two independent reviewers extracted bias risk, treatment details, patient characteristics and clinical outcomes. Random effect meta-analysis was performed. Results: 1054 studies were identified in our electronic search, 136 trials were assessed for eligibility and 26 trials with 1733 critically ill patients were included. The median methodologic score was 9 out of 14 points (95% confidence interval CI] 7, 10). Omega-6 FA sparing PN in comparison with traditional lipid emulsions did not decrease overall mortality (20 studies; risk ratio RR] 0.91; 95% CI 0.76, 1.10; p= 0.34) but hospital length of stay was substantially reduced (6 studies; weighted mean difference WMD] - 6.88; 95% CI - 11.27, - 2.49; p= 0.002). Among the different lipid emulsions, fish oil (FO) containing PN reduced the length of intensive care (8 studies; WMD -3.53; 95% CI - 6.16, - 0.90; p= 0.009) and rate of infectious complications (4 studies; RR 0.65; 95% CI 0.44, 0.95; p= 0.03). When FO was administered as a stand-alone medication outside PN, potential mortality benefits were observed compared to standard care. Conclusion: Overall, these findings highlight distinctive omega-6 sparing effects attributed to PN. Among the different lipid emulsions, FO in combination with PN or as a stand-alone treatment may have the greatest clinical impact.
format Article
author Notz, Quirin
Lee, Zheng-Yii
Menger, Johannes
Elke, Gunnar
Hill, Aileen
Kranke, Peter
Roeder, Daniel
Lotz, Christopher
Meybohm, Patrick
Heyland, Daren K.
Stoppe, Christian
author_facet Notz, Quirin
Lee, Zheng-Yii
Menger, Johannes
Elke, Gunnar
Hill, Aileen
Kranke, Peter
Roeder, Daniel
Lotz, Christopher
Meybohm, Patrick
Heyland, Daren K.
Stoppe, Christian
author_sort Notz, Quirin
title Omega-6 sparing effects of parenteral lipid emulsions-an updated systematic review and meta-analysis on clinical outcomes in critically ill patients
title_short Omega-6 sparing effects of parenteral lipid emulsions-an updated systematic review and meta-analysis on clinical outcomes in critically ill patients
title_full Omega-6 sparing effects of parenteral lipid emulsions-an updated systematic review and meta-analysis on clinical outcomes in critically ill patients
title_fullStr Omega-6 sparing effects of parenteral lipid emulsions-an updated systematic review and meta-analysis on clinical outcomes in critically ill patients
title_full_unstemmed Omega-6 sparing effects of parenteral lipid emulsions-an updated systematic review and meta-analysis on clinical outcomes in critically ill patients
title_sort omega-6 sparing effects of parenteral lipid emulsions-an updated systematic review and meta-analysis on clinical outcomes in critically ill patients
publisher BioMed Central
publishDate 2022
url http://eprints.um.edu.my/33474/
_version_ 1740826033777541120
score 13.211869

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