Effect of enteral diet enriched with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with sepsis-induced acute respiratory distress syndrome

Abstract

Background: In this study, the effects of an enteral diet enriched with eicosapentaenoic acid (EPA), γ-linolenic acid (GLA), and antioxidants were compared with a standard enteral diet in critically ill patients with sepsis-induced acute respiratory distress syndrome (ARDS).

Methods: This study was a single-center, prospective, randomized, single-blind, controlled trial in our Advanced Critical Care Center. Patients were randomized to receive a continuous EPA, GLA, and antioxidant-enriched diet (study group), or an isocaloric standard diet (control group).

Results: Twenty-three of 46 patients were in the study group, and the other 23 were in the control group. Duration of mechanical ventilation, incidence of new nosocomial infections, changes over time in Sequential Organ Failure Assessment (SOFA) scores, and 60-day mortality were not significantly different between the two groups. The ratio of partial pressure of oxygen to fraction of inspired oxygen on day 7 was significantly higher in the study group (233.0 [185.5-282.8] vs. 274.0 [225.5-310.8], p = 0.021). Duration of ICU stay was significantly shorter in the study group than in the control group (24.0 [20.0-30.0] vs. 15.0 [11.0-24.0], p = 0.008).

Conclusions: An enteral diet enriched with EPA, GLA, and antioxidants did not improve duration of mechanical ventilation, SOFA score, incidence of new nosocomial infections, or mortality but did favorably influence duration of ICU stay in critically ill patients with sepsis-induced ARDS.

Keywords: Acute respiratory distress syndrome; Antioxidants; Eicosapentaenoic acid; Enteral nutrition; Gamma-linolenic acid; Sepsis.

Figure 1

Patient flow across the study. MV, mechanical ventilation.

Figure 2

Survival curves generated by Kaplan-Meier survival analysis, representing primary and secondary clinical outcomes. (a) Duration of mechanical ventilation. (b) Duration of ICU stay. The sole reason for censoring was that three patients in each group died before completing the study (on days 14, 23, and 23 in the control group and on days 19, 21, and 21 in the study group). One patient in the control group died on day 23 but was extubated on day 22. Cum, cumulative.

Figure 3

Box plots of changes in SOFA scores and PaO₂/FiO₂ over time. Circles represent data below 1.5 × IQR of the lower quartile or above 1.5 × IQR of the upper quartile. (a) SOFA scores. The number of patients for each day point is 23 for each group since the first censored case is at day 14. (b) PaO₂/FiO₂ ratios. The numbers of patients analyzed for each day point are the following: 23 vs. 23 (day 1), 23 vs. 23 (day 3), 23 vs. 23 (day 5), 23 vs. 22 (day 7), 18 vs. 21 (day 9), 12 vs. 14 (day 14), which is noted as “the study group” vs. “the control group”.