1Food and Nutrition Services Department, Fraser Health Authority, Burnaby, BC, Canada. 2Department of Nutritional Sciences, School of Health Related Professions, Rutgers, The State University of New Jersey, Newark, NJ. 3Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada. 4Department of Medicine, Queen's University, Kingston, ON, Canada.
Crit Care Med. 2014 May;42(5):1168-77. doi: 10.1097/CCM.0000000000000146.
To examine the effects of different IV fat emulsions on clinical outcomes in critically ill patients.
Secondary analysis of data from a prospective multicenter study.
An international sample of ICUs.
Adult patients who were admitted to the ICU for more than 72 hours, were mechanically ventilated within 48 hours, received exclusive parenteral nutrition for more than or equal to 5 days, and did not change IV fat emulsion type during the data collection period.
Demographic and clinical data were collected for up to 12 days, until death, or discharge from the ICU, whichever came first. Clinical outcomes were recorded at 60 days following ICU admission.
Lipid-free, soybean, medium-chain triglyceride, olive, and fish oils in parenteral nutrition were compared using an adjusted Cox proportional hazard model to examine time to termination of mechanical ventilation alive, time to ICU discharge alive, and time to hospital discharge alive.
A total of 451 patients were included in this study: 70 (15.5%) in the lipid-free group, 223 (49.5%) in the soybean oil group, 65 (14.4%) in the medium-chain triglyceride group, 74 (16.4%) in the olive oil group, and 19 (4.9%) in the fish oil group. When compared with lipid-free parenteral nutrition, patients who received fish oil had a faster time to ICU discharge alive (hazard ratio, 1.84; 95% CI, 1.01-3.34; p = 0.05). When compared with soybean oil, patients who received olive oil or fish oil had a shorter time to termination of mechanical ventilation alive (hazard ratio, 1.43; 95% CI, 1.06-1.93; p = 0.02 and hazard ratio, 1.67; 95% CI, 1.00-2.81; p = 0.05, respectively) and a shorter time to ICU discharge alive (hazard ratio, 1.76; 95% CI, 1.30-2.39; p < 0.001 and hazard ratio, 2.40; 95% CI, 1.43-4.03; p = 0.001, respectively).
Use of alternative IV fat emulsions in parenteral nutrition, particularly olive and fish oil, was associated with improved clinical outcomes.
研究不同 IV 脂肪乳剂对危重症患者临床结局的影响。
前瞻性多中心研究数据的二次分析。
国际 ICU 样本。
入住 ICU 超过 72 小时、入住 ICU 后 48 小时内接受机械通气、接受全肠外营养超过或等于 5 天且在数据收集期间未改变 IV 脂肪乳剂类型的成年患者。
在最多 12 天的时间内收集人口统计学和临床数据，直至死亡或 ICU 出院，以先发生者为准。在 ICU 入院后 60 天记录临床结局。
使用调整后的 Cox 比例风险模型比较肠外营养中的无脂、大豆、中链甘油三酯、橄榄油和鱼油，以检查机械通气存活时间、ICU 出院存活时间和住院出院存活时间的终止时间。
本研究共纳入 451 例患者：无脂组 70 例（15.5%）、大豆油组 223 例（49.5%）、中链甘油三酯组 65 例（14.4%）、橄榄油组 74 例（16.4%）和鱼油组 19 例（4.9%）。与无脂肠外营养相比，接受鱼油的患者 ICU 出院存活时间更快（风险比，1.84；95%CI，1.01-3.34；p = 0.05）。与大豆油相比，接受橄榄油或鱼油的患者机械通气存活时间终止更快（风险比，1.43；95%CI，1.06-1.93；p = 0.02 和风险比，1.67；95%CI，1.00-2.81；p = 0.05，分别），ICU 出院存活时间更短（风险比，1.76；95%CI，1.30-2.39；p <0.001 和风险比，2.40；95%CI，1.43-4.03；p = 0.001，分别）。
在肠外营养中使用替代 IV 脂肪乳剂，特别是橄榄油和鱼油，与改善临床结局相关。
Zotero 插件