Intravenous fish oil lipid emulsions in critically ill patients: an updated systematic review and meta-analysis.
Intravenous fish oil lipid emulsions in critically ill patients: an updated systematic review and meta-analysis.
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DOI：
10.1186/s13054-015-0888-7
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发表时间：
2015-04-16
期刊：
影响因子：
--
通讯作者：
Heyland DK
中科院分区：
文献类型：
--
作者：
Manzanares W;Langlois PL;Dhaliwal R;Lemieux M;Heyland DK
静脉注射鱼油（FO）脂肪乳剂（LE）富含ω-3多不饱和脂肪酸，具有抗炎和免疫调节作用。我们以前证明，含FO的LE可能能够降低危重患者的死亡率和通气天数。自2014年以来，已发表了几项额外的含FO LE的随机对照试验（RCT）。因此，本系统性综述的目的是更新我们之前的系统性综述，旨在阐明含FO LE对危重患者临床结局的疗效。我们检索了1980年至2014年的电子数据库。我们纳入了在重症成人患者中进行的四项新的RCT，研究人员在这些研究中评价了胃肠外或肠内喂养患者中含FO的LE。共有10项RCT（n = 733）符合入选标准。平均方法学评分为8分（范围3 - 12分）。当我们汇总5个报告感染的RCT结果时，我们发现含FO的LE显著降低感染（风险比（RR）= 0.64; 95%置信区间（CI），0.44 - 0.92; P = 0.02;异质性I2 = 0%）。亚组分析表明，以肠内营养为主的试验显示出死亡率降低的趋势（RR = 0.69; 95%CI，0.40 - 1.18; P =0.18;异质性I2 =35%）。高质量的试验显示住院时间（LOS）显著缩短（加权平均差异=-7.42; 95%CI，-11.89至-2.94; P = 0.001），而低质量的试验没有影响（P = 0.45）。医院LOS亚组差异的检验结果具有显著性（P = 0.001）。含FO的LE可能与感染的减少有关，也可能与通气持续时间和医院LOS的减少有关。进一步的大规模随机对照试验是必要的，应该旨在巩固潜在的积极治疗效果。
Intravenous fish oil (FO) lipid emulsions (LEs) are rich in ω-3 polyunsaturated fatty acids, which exhibit anti-inflammatory and immunomodulatory effects. We previously demonstrated that FO-containing LEs may be able to decrease mortality and ventilation days in patients who are critically ill. Since 2014, several additional randomized controlled trials (RCTs) of FO-containing LEs have been published. Therefore, the purpose of this systematic review was to update our previous systematic review with the aim of elucidating the efficacy of FO-containing LEs on clinical outcomes of patients who are critically ill. We searched electronic databases from 1980 to 2014. We included four new RCTs conducted in critically ill adult patients in which researchers evaluated FO-containing LEs in parenterally or enterally fed patients. A total of 10 RCTs (n = 733) met inclusion criteria. The mean methodological score was 8 (range, 3 to 12). No effect on overall mortality was found. When we aggregated the results of five RCTs in which infections were reported, we found that FO-containing LEs significantly reduced infections (risk ratio (RR) = 0.64; 95% confidence interval (CI), 0.44 to 0.92; P = 0.02; heterogeneity I2 = 0%). Subgroup analysis demonstrated that predominantly enteral nutrition–based trials showed a tendency toward a reduction in mortality (RR = 0.69; 95% CI, 0.40 to 1.18; P =0.18; heterogeneity I2 =35%). High-quality trials showed a significant reduction in hospital length of stay (LOS) (weighted mean difference = −7.42; 95% CI, −11.89 to −2.94; P = 0.001), whereas low-quality trials had no effect (P = 0.45). The results of the test for subgroup differences in hospital LOS was significant (P = 0.001). FO-containing LEs may be associated with a reduction in infections and also could be associated with a reduction in duration of ventilation and hospital LOS. Further large-scale RCTs are warranted and should be aimed at consolidating potential positive treatment effects.
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DOI：
10.1177/0148607104028003142
发表时间：
2004-05-01
期刊：
JPEN. Journal of parenteral and enteral nutrition
影响因子：
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作者：
Antebi, H;Mansoor, O;Alcindor, L G
通讯作者：
Alcindor, L G
影响因子：
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作者：
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影响因子：
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作者：
Burkhart, C. S.;Dell-Kuster, S.;Steiner, L. A.
通讯作者：
Steiner, L. A.
DOI：
10.1159/000365667
发表时间：
2015-01-01
期刊：
INTRAVENOUS LIPID EMULSIONS
影响因子：
--
作者：
Hecker, Matthias;Mayer, Konstantin
通讯作者：
Mayer, Konstantin
DOI：
10.1186/cc8844
发表时间：
2010
期刊：
Critical care (London, England)
影响因子：
--
作者：
Barbosa VM;Miles EA;Calhau C;Lafuente E;Calder PC
通讯作者：
Calder PC