Influence of n-3 Polyunsaturated Fatty Acids Enriched Lipid Emulsions on Nosocomial Infections and Clinical Outcomes in Critically Ill Patients: ICU Lipids Study
Influence of n-3 Polyunsaturated Fatty Acids Enriched Lipid Emulsions on Nosocomial Infections and Clinical Outcomes in Critically Ill Patients: ICU Lipids Study
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DOI：
10.1097/ccm.0000000000000612
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发表时间：
2015-01-01
影响因子：
8.8
通讯作者：
Mesejo, Alfonso
中科院分区：
文献类型：
--
作者：
Grau-Carmona, Teodoro;Bonet-Saris, Alfonso;Mesejo, Alfonso
目的：已经证明，n-3多不饱和脂肪酸（包含在鱼油中）有益地影响外科患者的感染率和临床结果，这可能是由于它们的免疫调节作用。相比之下，危重患者鱼油给药的研究结果存在争议。本研究的目的是调查n-3多不饱和脂肪酸对内科和外科危重患者医院感染患病率和临床结局的影响。设计：前瞻性、多中心、随机、比较、双盲研究。设置：17个西班牙ICU在4年期间。受试者：共有159名内科和外科重症监护患者的急性生理学和慢性健康评价II评分≥ 13，干预措施：患者接受全胃肠外营养，用含有10%鱼油的脂肪乳剂或不含鱼油的脂肪乳剂制备。在28天的ICU住院期间检测医院感染的患病率。患者从ICU出院后6个月进行随访，了解住院时间、住院死亡率和6个月死亡率。在接受鱼油治疗的患者中，医院感染的患者数量显著减少（21.0% vs 37.2%，p = 0.035），预计无感染时间延长（21 ± 2 vs 16 ± 2 d，p = 0.03）。ICU，医院，6个月mortals.Conclusions：结果表明，管理的n-3多不饱和脂肪酸降低了医院感染的风险，并增加了预测的时间无感染的危重内科和外科患者。n-3多不饱和脂肪酸的给药安全且耐受性良好。
Objective: n-3 polyunsaturated fatty acids (contained in fish oil) have been shown to beneficially influence infection rate and clinical outcomes in surgical patients probably due to their immunomodulatory action. In contrast, study results of fish oil administration in critically ill patients are controversial. The aim of this study was to investigate the effects of n-3 polyunsaturated fatty acids on the prevalence of nosocomial infections and clinical outcomes in medical and surgical critically ill patients.Design: Prospective, multicenter, randomized, comparative, double-blind study.Setting: Seventeen Spanish ICUs during 4 years.Subjects: A total of 159 medical and surgical intensive care patients with Acute Physiology and Chronic Health Evaluation II score more than or equal to 13, expected to require total parenteral nutrition for at least 5 days.Interventions: Patients received total parenteral nutrition prepared either with a lipid emulsion containing 10% fish oil or a fish oil-free lipid emulsion. The prevalence of nosocomial infections was detected during 28 days of ICU stay. Patients were followed 6 months after discharge from the ICU for length of hospital stay, hospital mortality, and 6-month mortality.Measurements and Main Results: The number of patients with nosocomial infections was significantly reduced in the fish oil-receiving group (21.0% vs 37.2%, p = 0.035) and the predicted time free of infection was prolonged (21 +/- 2 vs 16 +/- 2 d, p = 0.03). No significant differences were detected for ICU, hospital, and 6-month mortality.Conclusions: The results show that administration of n-3 polyunsaturated fatty acids reduces the risk of nosocomial infections and increases the predicted time free of infections in critically ill medical and surgical patients. The administration of n-3 polyunsaturated fatty acids was safe and well tolerated.