Journal Article

Alternative lipid emulsions in the critically ill: a systematic review of the evidence

Dhaliwal, Rupinder, Manzanares, William, Stapleton, Renee D., Jurewitsch, Brian, Heyland, Daren K., Jeejeebhoy, Khursheed N.

2013

Overview

Purpose Parenteral lipid emulsions (LEs) are commonly rich in long-chain triglycerides derived from soybean oil (SO). SO-containing emulsions may promote systemic inflammation and therefore may adversely affect clinical outcomes. We hypothesized that alternative oil-based LEs (SO-sparing strategies) may improve clinical outcomes in critically ill adult patients compared to products containing SO emulsion only. The purpose of this systematic review was to evaluate the effect of parenteral SO-sparing strategies on clinical outcomes in intensive care unit (ICU) patients. Methods We searched computerized databases from 1980 to 2013. We included randomized controlled trials (RCTs) conducted in critically ill adult patients that evaluated SO-sparing strategies versus SO-based LEs in the context of parenteral nutrition. Results A total of 12 RCTs met the inclusion criteria. When the results of these RCTs were statistically aggregated, SO-sparing strategies were associated with clinically important reductions in mortality (risk ratio, RR 0.83; 95 % confidence intervals, CI 0.62, 1.11; P  = 0.20), in duration of ventilation (weighted mean difference, WMD −2.57; 95 % CI −5.51, 0.37; P  = 0.09), and in ICU length of stay (LOS) (WMD −2.31; 95 % CI −5.28, 0.66; P  = 0.13) but none of these differences were statistically significant. SO-sparing strategies had no effect on infectious complications (RR 1.13; 95 % CI 0.87, 1.46; P  = 0.35). Conclusion Alternative oil-based LEs may be associated with clinically important reductions in mortality, duration of ventilation, and ICU LOS but lack of statistical precision precludes any clinical recommendations at this time. Further research is warranted to confirm these potential positive treatment effects.

• Publisher: Springer Berlin Heidelberg,Springer,Springer Nature B.V
• Subject: Adult / Anesthesiology / Clinical outcomes / Clinical trials / Comparative analysis / Critical care / Critical Care Medicine / Critical Illness - therapy / Databases, Bibliographic / Emergency Medicine / Emulsions - administration & dosage / Emulsions - adverse effects / Emulsions - therapeutic use / Fat Emulsions, Intravenous - adverse effects / Fat Emulsions, Intravenous - chemistry / Fat Emulsions, Intravenous - therapeutic use / Fish Oils - administration & dosage / Fish Oils - adverse effects / Fish Oils - therapeutic use / Health aspects / Hospital patients / Humans / Immune System - drug effects / Immune System - physiology / Infections / Inflammation / Inflammation - etiology / Inflammation - prevention & control / Intensive / Intensive care / Intensive Care Units / Lecithins - administration & dosage / Lecithins - adverse effects / Lecithins - therapeutic use / Length of stay / Lipids / Medical colleges / Medicine / Medicine & Public Health / Mortality / Nutrition / Oxidative Stress - drug effects / Oxidative Stress - physiology / Pain Medicine / Parenteral nutrition / Parenteral Nutrition - adverse effects / Parenteral Nutrition - methods / Pediatrics / Phospholipids - administration & dosage / Phospholipids - adverse effects / Phospholipids - therapeutic use / Plant Oils - administration & dosage / Plant Oils - adverse effects / Plant Oils - therapeutic use / Pneumology/Respiratory System / Randomized Controlled Trials as Topic / Safflower Oil - administration & dosage / Safflower Oil - adverse effects / Safflower Oil - therapeutic use / Soybean / Soybean Oil - administration & dosage / Soybean Oil - adverse effects / Soybean Oil - therapeutic use / Soybeans / Systematic Review / Treatment Outcome / Triglycerides / Triglycerides - administration & dosage / Triglycerides - adverse effects / Triglycerides - therapeutic use / Vegetable oils / Ventilators