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Meta-Analysis
. 2013 Oct;39(10):1683-94.
doi: 10.1007/s00134-013-2999-4. Epub 2013 Jun 29.

Alternative lipid emulsions in the critically ill: a systematic review of the evidence

William Manzanares  1 , Rupinder Dhaliwal, Brian Jurewitsch, Renee D Stapleton, Khursheed N Jeejeebhoy, Daren K Heyland
Affiliations
Meta-Analysis

Alternative lipid emulsions in the critically ill: a systematic review of the evidence

William Manzanares et al. Intensive Care Med. 2013 Oct.

Abstract

Purpose: Parenteral lipid emulsions (LEs) are commonly rich in long-chain triglycerides derived from soybean oil (SO). SO-containing emulsions may promote systemic inflammation and therefore may adversely affect clinical outcomes. We hypothesized that alternative oil-based LEs (SO-sparing strategies) may improve clinical outcomes in critically ill adult patients compared to products containing SO emulsion only. The purpose of this systematic review was to evaluate the effect of parenteral SO-sparing strategies on clinical outcomes in intensive care unit (ICU) patients.

Methods: We searched computerized databases from 1980 to 2013. We included randomized controlled trials (RCTs) conducted in critically ill adult patients that evaluated SO-sparing strategies versus SO-based LEs in the context of parenteral nutrition.

Results: A total of 12 RCTs met the inclusion criteria. When the results of these RCTs were statistically aggregated, SO-sparing strategies were associated with clinically important reductions in mortality (risk ratio, RR 0.83; 95 % confidence intervals, CI 0.62, 1.11; P = 0.20), in duration of ventilation (weighted mean difference, WMD -2.57; 95 % CI -5.51, 0.37; P = 0.09), and in ICU length of stay (LOS) (WMD -2.31; 95 % CI -5.28, 0.66; P = 0.13) but none of these differences were statistically significant. SO-sparing strategies had no effect on infectious complications (RR 1.13; 95 % CI 0.87, 1.46; P = 0.35).

Conclusion: Alternative oil-based LEs may be associated with clinically important reductions in mortality, duration of ventilation, and ICU LOS but lack of statistical precision precludes any clinical recommendations at this time. Further research is warranted to confirm these potential positive treatment effects.

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Conflict of interest statement

Competing interests

The other authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Overall effect on Mortality of LCT (Omega-6 reducing strategy) vs. LCT Abbreviations: LCT: long chain triglycerides; MCT: medium chain triglycerides; 95% CI: 95% confidence intervals
Figure 2
Figure 2
Overall effect on ventilation days of Omega 6 reducing strategy vs. LCT Abbreviations: LCT: long chain triglycerides; 95% CI: 95% confidence intervals; SD: standard deviation
Figure 3
Figure 3
Overall effect on ICU LOS of Omega 6 reducing strategy vs. LCT Abbreviations: LCT: long chain triglycerides; MCT: medium chain triglycerides; 95% CI: 95% confidence intervals; SD: standard deviation
See this image and copyright information in PMC

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