Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Laboratory of Nutrition and Metabolism Research, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
Clin Nutr. 2021 May;40(5):2544-2554. doi: 10.1016/j.clnu.2021.03.034. Epub 2021 Apr 1.
BACKGROUND & AIMS: Enteral nutrition (EN) and parenteral nutrition (PN) enriched with omega-3 polyunsaturated fatty acids (PUFA) have beneficial effects in critical illness. This study aimed to assess the combined effect of EN and supplemental PN enriched with omega-3 PUFA on blood oxygenation in intensive care unit (ICU) patients.
Single-center, prospective, randomized, controlled, double-blind, phase III trial conducted from 10/2013 to 11/2017. A total of 100 ICU patients (18-85 years, APACHE II score > 15) requiring mechanical ventilation were randomly assigned to received combined EN and PN either with omega-3 PUFA (omega-3 group) or without (control group) for up to 28 days. Primary endpoint: 'change of PaO/FiO from day (D) 1 to D4'. Secondary endpoints: lung function parameters, ICU complications, length of hospital stay, days free of ICU care/ventilation/sedation/catecholamine treatment, mortality, erythrocyte fatty acid composition, inflammatory parameters. Safety parameters: standard laboratory assessment, vital signs, physical examination, SOFA score, adverse events.
Combined EN and PN covered energy requirements to more than 80%. Blood oxygenation (ΔPaO/FiO from D1 to D4: -1.3 ± 83.7, n = 42, and 13.3 ± 86.1, n = 39, in omega-3 and control group, respectively, p = 0.7795) and other lung function parameters did not differ between groups but days free of catecholamine treatment were significantly higher in the omega-3 group (~4 days, p = 0.0481). On D6, significantly more patients in the omega-3 group tolerated EN alone (51.0% vs. 29.8%, p = 0.0342). Eicosapentaenoic acid (EPA) content in erythrocytes was significantly increased in the omega-3 group at last observation compared with the control group (ΔEPA: 0.928 ± 0.808% vs. -0.024 ± 0.190%, p < 0.0001). No further significant group differences were detected.
Enteral and supplemental PN both enriched with omega-3 PUFA did not improve lung function but allowed earlier weaning from catecholamine treatment and PN. Supplemental PN succeeded to adequately cover energy requirements in critically ill patients.
www.clinicaltrials.gov, registration number: NCT01162928.
肠内营养（EN）和富含ω-3 多不饱和脂肪酸（PUFA）的肠外营养（PN）在危重病中有有益作用。本研究旨在评估富含ω-3 PUFA 的 EN 和补充性 PN 联合应用对重症监护病房（ICU）患者的血液氧合的影响。
单中心、前瞻性、随机、对照、双盲、III 期临床试验，于 2013 年 10 月至 2017 年 11 月进行。共纳入 100 名需要机械通气的 ICU 患者（18-85 岁，APACHE II 评分>15），随机分为接受富含 ω-3 PUFA 的联合 EN 和 PN（ω-3 组）或不接受（对照组）治疗，持续 28 天。主要终点：“从第 1 天（D1）到第 4 天（D4）的 PaO/FiO 变化”。次要终点：肺功能参数、ICU 并发症、住院时间、无 ICU 护理/通气/镇静/儿茶酚胺治疗天数、死亡率、红细胞脂肪酸组成、炎症参数。安全性参数：标准实验室评估、生命体征、体格检查、SOFA 评分、不良事件。
联合 EN 和 PN 可满足超过 80%的能量需求。两组间的血液氧合（从 D1 到 D4 的 PaO/FiO 变化：-1.3±83.7，n=42 和 13.3±86.1，n=39，分别在 ω-3 和对照组，p=0.7795）和其他肺功能参数无差异，但 ω-3 组儿茶酚胺治疗天数明显更长（~4 天，p=0.0481）。在 D6，ω-3 组有更多患者能耐受单独的 EN（51.0%比 29.8%，p=0.0342）。与对照组相比，ω-3 组红细胞中二十碳五烯酸（EPA）的含量在最后一次观察时明显增加（ΔEPA：0.928±0.808%比-0.024±0.190%，p<0.0001）。未发现其他有意义的组间差异。
富含 ω-3 PUFA 的肠内和补充性 PN 均未改善肺功能，但允许更早地停止儿茶酚胺治疗和 PN。补充性 PN 成功地满足了危重症患者的能量需求。
