ICU length of stay reduced when supplement with Omega-3 – meta-analysis July 2018

Current Evidence on Omega-3 Fatty Acids in Enteral Nutrition in the Critically ill – a systematic review and meta-analysis

Nutrition, online 31 July 2018, https://doi.org/10.1016/j.nut.2018.07.013

 Download the PDF from VitaminDWiki

Highlights

• Enteral fish oil confers anti-inflammatory and immunomodulatory effects.
• No evidence for improved mortality from enteral fish oil supplementation among critically ill patients was found.
• ICU length of stay and duration of ventilation was significantly shorter with fish oil, however results were based on heterogeneous studies.
• Reduced mortality in ARDS patients was found, however studies had low methodological quality.
• Enteral fish oil supplementation cannot be recommended for critically ill patients.
• Further research should focus on the relation between the individual critically ill patients’ immune response, the administration of fish oil and clinical outcomes.

Introduction
: As fish oil exerts anti-inflammatory and immunomodulatory properties which may be beneficial for critically ill patients, multiple RCTs and meta-analysis have been performed. However, controversy remains as to whether fish oil enriched enteral nutrition can improve clinical outcomes in adult critically ill patients in intensive care units.

Methods
: A systematic literature search was conducted. The primary outcome was 28-day mortality. Secondary outcomes were ICU and hospital mortality, ICU and hospital length of stay, ventilation duration and infectious complications. Predefined subgroup and sensitivity analyses were performed.

Results
: Twenty-four trials, enrolling 3574 patients, met the inclusion criteria. The assessment of risk of bias showed that most of included studies were of moderate quality. The overall results revealed no significant effects of enteral fish oil supplementation on 28-day, ICU or hospital mortality. However, ICU LOS and ventilation duration were significantly reduced in patients receiving fish oil supplementation. Furthermore, subgroup analysis revealed a significant reduction in 28-day mortality, ICU LOS and ventilation duration in ARDS patients but not in other subgroups. When comparing high with low quality trials, significant reductions in 28-day mortality and ventilation duration in low but not high quality trials were observed. Regarding ICU LOS a significant reduction was observed in high quality trials whereas only a trend was observed in low quality trials. No significant effects on hospital LOS or infectious complications were observed in overall or subgroup analyses.

Conclusions
: Enteral fish oil supplementation cannot be recommended for critically ill patients as strong scientific evidence for improved clinical benefits could not be found. There is a signal of mortality benefit in ARDS patients, however results are based on low quality studies. Further research should focus on the relation between the individual critically ill patients’ immune response, the administration of fish oil and clinical outcomes.