Effects of enteral feeding with eicosapentaenoic acid, γ-linolenic acid, and antioxidants in mechanically ventilated patients with severe sepsis and septic shock
Effects of enteral feeding with eicosapentaenoic acid, γ-linolenic acid, and antioxidants in mechanically ventilated patients with severe sepsis and septic shock
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DOI：
10.1097/01.ccm.0000234033.65657.b6
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发表时间：
2006-09-01
影响因子：
8.8
通讯作者：
Albuquerque, Juliana Deusdara
中科院分区：
文献类型：
--
作者：
Pontes-Arruda, Alessandro;Albuquerque Aragao, Afra Maria;Albuquerque, Juliana Deusdara
目的：富含二十碳五烯酸（EPA）、γ-亚麻酸（GLA）和抗氧化剂的肠内饮食先前已被证明可改善急性呼吸窘迫综合征患者的预后。几项使用败血症动物模型的研究表明，富含ω-3脂肪酸的肠内营养可降低死亡率。本研究调查了富含EPA、GLA和抗氧化维生素的肠内饮食是否可以改善需要机械通气的严重脓毒症或脓毒性休克患者的结局并降低28天全因死亡率。设计：前瞻性、双盲、安慰剂对照、随机试验。设置：巴西三级医院的三个不同重症监护室。患者：本研究招募了165名患者。干预措施：患者被随机连续管喂养的饮食富含EPA，GLA，和升高的抗氧化剂或等氮和等热量的控制饮食，以恒定的速度提供，以达到最低的75%的基础能量消耗x 1.3在最低的4 days. Measures和主要结果：患者进行了监测28天。与对照饮食喂养的患者相比，研究饮食喂养的患者的死亡率显著降低，绝对死亡率降低了19.4%（p = 0.037）。接受研究饮食的一组也经历了氧合状态的显著改善，（13.4 +/- 1.2 vs. 5.8 +/- 1.0，p < .001），无重症监护室（ICU）天数更多（10.8 ± 1.1 vs. 4.6 ± 0.9，p <0.001），新器官功能障碍的发生较少（P
Objectives: Enteral diets enriched with eicosapentaenoic acid (EPA), gamma-linolenic acid (GLA), and antioxidants have previously been shown to improve outcomes in patients with acute respiratory distress syndrome. Several studies using animal models of sepsis demonstrate that enteral nutrition enriched with omega-3 fatty acids reduces mortality rate. This study investigated whether an enteral diet enriched with EPA, GLA, and antioxidant vitamins can improve outcomes and reduce 28-day all-cause mortality in patients with severe sepsis or septic shock requiring mechanical ventilation.Design: Prospective, double-blind, placebo-controlled, randomized trial.Setting: Three different intensive care units of a tertiary hospital in Brazil.Patients: The study enrolled 165 patients.Interventions: Patients were randomized to be continuously tube-fed with either a diet enriched with EPA, GLA, and elevated antioxidants or an isonitrogenous and isocaloric control diet, delivered at a constant rate to achieve a minimum of 75% of basal energy expenditure x 1.3 during a minimum of 4 days.Measurements and Main Results: Patients were monitored for 28 days. Patients who were fed with the study diet experienced a significant reduction in mortality rate compared with patients fed with the control diet, the absolute mortality reduction amounting to 19.4% (p = .037). The group who received the study diet also experienced significant improvements in oxygenation status, more ventilator-free days (13.4 +/- 1.2 vs. 5.8 +/- 1.0, p < .001), more intensive care unit (ICU)-free days (10.8 +/- 1.1 vs. 4.6 +/- 0.9, p < .001), and a lesser development of new organ dysfunctions (P