Effect of enteral feeding with eicosapentaenoic acid, γ-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome
Effect of enteral feeding with eicosapentaenoic acid, γ-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome
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DOI：
10.1097/00003246-199908000-00001
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发表时间：
1999-08-01
影响因子：
8.8
通讯作者：
Noursalehi, M
中科院分区：
文献类型：
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作者：
Gadek, JE;DeMichele, SJ;Noursalehi, M
目的：最近对脓毒症诱导的急性呼吸窘迫综合征(ARDS)动物模型的研究表明，低碳水化合物、高脂肪饮食结合了二十碳五烯酸(EPA；鱼油)、伽马亚麻酸(GLA；萝卜油)(EPA+GLA)的抗炎和血管扩张特性，以及抗氧化剂改善肺微血管通透性、氧合作用和心肺功能，减少促炎性二十烷类合成和肺部炎症。设计：前瞻性、多中心、双盲、随机对照试验。地点：美国五家学术和教学医院的重症监护室。患者：我们纳入了146名因败血症/肺炎、创伤或吸入损伤引起的ARDS患者。干预：符合入选标准的患者被随机分为EPA+GLA或等氮持续管饲，至少4-7天的等卡标准饮食，热量输出量至少为基础能量消耗的75%×1.3。测量和主要结果：测量动脉血气，并记录基线和研究第4天和第7天的呼吸机设置，以便于计算PaO(2)/FiO(2)(衡量气体交换的指标)。同时测定肺泡灌洗液中中性粒细胞数和细胞总数，以评估肺中性粒细胞募集情况。记录临床结果。98名可评估患者的基线特征显示，两组患者在入院时关键的人口统计学、生理学和呼吸机变量相似。在使用EPA+GLA的研究期间，多次支气管肺泡灌洗显示，与喂食对照饮食的患者相比，每毫升回收灌洗液的细胞总数和中性粒细胞数量显著减少(类似于2.5倍)。与对照组相比，服用EPA+GLA的患者在研究的第4天和第7天的氧合(PaO(2)/Fio(2))有了显著的改善，这些患者的呼吸参数(Ro，呼气末正压和分钟通气量)较低。与对照组相比，服用EPA+GLA的患者所需的机械支持天数显著减少(11天比16.3天；p=.011)，在重症监护病房的停留时间也减少(12.8天比17.5天；p=.016)。在研究期间，服用EPA+GLA的51名患者中只有4名(8%)发生了新的器官衰竭，而对照组47名患者中只有13名(28%)出现了新的器官衰竭(p=.015)。结论：EPA+GLA饮食对肺中性粒细胞募集、气体交换、机械通气需求、重症监护病房住院时间和新器官衰竭的减少的有益影响表明，这种肠内营养配方将是临床治疗ARDS患者或有发生ARDS风险的患者的一种有用的辅助治疗方法。
Objectives: Recent studies in animal models of sepsis-induced acute respiratory distress syndrome (ARDS) have shown that a low-carbohydrate, high-fat diet combining the anti-inflammatory and vasodilatory properties of eicosapentaenoic acid (EPA; fish oil), gamma-linolenic acid (GLA; borage oil) (EPA+GLA), and antioxidants improves lung microvascular permeability, oxygenation, and cardiopulmonary function and reduces proinflammatory eicosanoid synthesis and lung inflammation. These findings suggest that enteral nutrition with EPA+GLA and antioxidants may reduce pulmonary inflammation and may improve oxygenation and clinical outcomes in patients with ARDS.Design: Prospective, multicentered, double-blind, randomized controlled trial.Setting: Intensive care units of five academic and teaching hospitals in the United States.Patients: We enrolled 146 patients with ARDS (as defined by the American-European Consensus Conference) caused by sepsis/pneumonia, trauma, or aspiration injury in the study.Interventions: Patients meeting entry criteria were randomized and continuously tube-fed either EPA+GLA or an isonitrogenous, isocaloric standard diet at a minimum caloric delivery of 75% of basal energy expenditure x 1.3 for at least 4-7 days.Measurements and Main Results: Arterial blood gases were measured, and ventilator settings were recorded at baseline and study days 4 and 7 to enable calculation of Pao(2)/Fio(2) a measure of gas exchange. Pulmonary neutrophil recruitment was assessed by measuring the number of neutrophils and the total cell count in bronchoalveolar lavage fluid at the same time points. Clinical outcomes were recorded. Baseline characteristics of 98 evaluable patients revealed that key demographic, physiologic, and ventilatory variables were similar at entry between both groups. Multiple bronchoalveolar lavages revealed significant decreases (similar to 2.5-fold) in the number of total cells and neutrophils per mt of recovered lavage fluid during the study with EPA+GLA compared with patients fed the control diet. Significant improvements in oxygenation (Pao(2)/Fio(2)) from baseline to study days 4 and 7 with lower ventilation variables (Ro,, positive end-expiratory pressure, and minute ventilation) occurred in patients fed EPA+GLA compared with controls. Patients fed EPA+GLA required significantly fewer days of ventilatory support (11 vs. 16.3 days; p = .011), and had a decreased length of stay in the intensive care unit (12.8 vs. 17.5 days; p = .016) compared with controls. Only four of 51 (8%) patients fed EPA+GLA vs. 13 of 47 (28%) control patients developed a new organ failure during the study (p = .015).Conclusions: The beneficial effects of the EPA+GLA diet on pulmonary neutrophil recruitment, gas exchange, requirement for mechanical ventilation, length of intensive care unit stay, and the reduction of new organ failures suggest that this enteral nutrition formula would be a useful adjuvant therapy in the clinical management of patients with or at risk of developing ARDS.