Pontes-Arruda Alessandro, Demichele Stephen, Seth Anand, Singer Pierre
Intensive Care Department, Fernandes Távora Hospital, Fortaleza, Ceará, Brazil.
JPEN J Parenter Enteral Nutr. 2008 Nov-Dec;32(6):596-605. doi: 10.1177/0148607108324203.
This meta-analysis of clinical trials compares an inflammation-modulating diet enriched with eicosapentaenoic acid (EPA), gamma-linolenic acid (GLA), and elevated antioxidants (EPA + GLA) vs a control diet to determine the effectiveness of this specialized diet on oxygenation and clinical outcomes in mechanically ventilated patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS).
MEDLINE, EMBASE, Cochrane Clinical Trials Register, and the U.S. National Institute of Health Clinical Trials databases were searched. The outcome measures assessed were 28-day in-hospital mortality, 28-day ventilator-free and intensive care unit (ICU)-free days, and the development of new organ failures. An evaluation of oxygenation and ventilatory variables was also performed. Outcomes were analyzed using both fixed-effects and random-effects models.
Three randomized controlled studies (n = 411 patients) were included in this meta-analysis. Among the most important findings of this evaluation is a significant reduction in the risk of mortality (odds ratio [OR] = 0.40; 95% confidence interval [CI] = 0.24-0.68; P = .001), with significant reductions in the risk of developing new organ failures (OR = 0.17; 95% CI = 0.08-0.34; P < .0001), time on mechanical ventilation (standardized mean difference [SMD] = 0.56; 95% CI = 0.32-0.79; P < .0001), and ICU stay (SMD = 0.51; 95% CI = 0.27-0.74; P < .0001) in patients who received EPA + GLA.
The meta-analysis showed a significant reduction in the risk of mortality as well as relevant improvements in oxygenation and clinical outcomes of ventilated patients with ALI/ARDS given EPA + GLA.
本项临床试验的荟萃分析比较了富含二十碳五烯酸（EPA）、γ-亚麻酸（GLA）及抗氧化剂水平升高的炎症调节饮食（EPA + GLA）与对照饮食，以确定这种特殊饮食对急性肺损伤（ALI）/急性呼吸窘迫综合征（ARDS）机械通气患者氧合及临床结局的有效性。
检索了MEDLINE、EMBASE、Cochrane临床试验注册库及美国国立卫生研究院临床试验数据库。评估的结局指标包括28天住院死亡率、28天无呼吸机及无重症监护病房（ICU）天数，以及新器官功能衰竭的发生情况。还对氧合及通气变量进行了评估。采用固定效应模型和随机效应模型对结局进行分析。
本荟萃分析纳入了三项随机对照研究（n = 411例患者）。该评估最重要的发现之一是，接受EPA + GLA的患者死亡率风险显著降低（优势比[OR] = 0.40；95%置信区间[CI] = 0.24 - 0.68；P = 0.001），新器官功能衰竭风险显著降低（OR = 0.17；95% CI = 0.08 - 0.34；P < 0.0001），机械通气时间显著缩短（标准化均数差[SMD] = 0.56；95% CI = 0.32 - 0.79；P < 0.0001），ICU住院时间显著缩短（SMD = 0.51；95% CI = 0.27 - 0.74；P < 0.0001）。
荟萃分析表明，给予EPA + GLA的ALI/ARDS机械通气患者死亡率风险显著降低，氧合及临床结局有相关改善。
