Research

Effects of a fish oil containing lipid emulsion on plasma phospholipid fatty acids, inflammatory markers, and clinical outcomes in septic patients: a randomized, controlled clinical trial

Vera M Barbosa^1,2 , Elizabeth A Miles¹ , Conceição Calhau³ , Estevão Lafuente² and Philip C Calder¹

¹  Institute of Human Nutrition, School of Medicine, University of Southampton, IDS Building, MP887 Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK

²  Hospital Padre Américo, Place of Tapadinha, Guilhufe, 4560-007 Penafiel, Portugal

³  Department of Biochemistry, School of Medicine, Oporto University, Alameda Prof. Hernani Monteiro, Oporto, 4200 - 319 Porto, Portugal

author email corresponding author email

Critical Care 2010, 14:R5doi:10.1186/cc8844

Published:	19 January 2010

See related commentary by Mayer and Seeger et al., http://ccforum.com/content/14/2/128

Abstract

Introduction

The effect of parenteral fish oil in septic patients is not widely studied. This study investigated the effects of parenteral fish oil on plasma phospholipid fatty acids, inflammatory mediators, and clinical outcomes.

Methods

Twenty-five patients with systemic inflammatory response syndrome or sepsis, and predicted to need parenteral nutrition were randomized to receive either a 50:50 mixture of medium-chain fatty acids and soybean oil or a 50:40:10 mixture of medium-chain fatty acids, soybean oil and fish oil. Parenteral nutrition was administrated continuously for five days from admission. Cytokines and eicosanoids were measured in plasma and in lipopolysaccharide-stimulated whole blood culture supernatants. Fatty acids were measured in plasma phosphatidylcholine.

Results

Fish oil increased eicosapentaenoic acid in plasma phosphatidylcholine (P < 0.001). Plasma interleukin (IL)-6 concentration decreased significantly more, and IL-10 significantly less, in the fish oil group (both P < 0.001). At Day 6 the ratio PO₂/FiO₂ was significantly higher in the fish oil group (P = 0.047) and there were fewer patients with PO₂/FiO₂ <200 and <300 in the fish oil group (P = 0.001 and P = 0.015, respectively). Days of ventilation, length of intensive care unit (ICU) stay and mortality were not different between the two groups. The fish oil group tended to have a shorter length of hospital stay (22 ± 7 vs. 55 ± 16 days; P = 0.079) which became significant (28 ± 9 vs. 82 ± 19 days; P = 0.044) when only surviving patients were included.

Conclusions

Inclusion of fish oil in parenteral nutrition provided to septic ICU patients increases plasma eicosapentaenoic acid, modifies inflammatory cytokine concentrations and improves gas exchange. These changes are associated with a tendency towards shorter length of hospital stay.

Trials Registration

Clinical Trials Registration Number ISRCTN89432944