Table 1.
Randomized clinical trial evaluating type of lipids (PN) in critically ill patients
| Study | Population | Methods (score) | Intervention | Mortality # (%)† | Infections # (%)‡ | ||
|---|---|---|---|---|---|---|---|
| Long Chain Triglyceride (LCT) plus Medium Chain Triglycerides (MCT) vs. LCT | |||||||
| Nijveldt 1998 | ICU, septic surgical patients, trauma N = 20 |
C. Random: not sure ITT: yes Blinding: double (10) |
PN + Lipofundin (50% LCT+ 50% MCT) vs. PN + Intralipid (100% LCT, soybean) |
LCT + MCT ICU 2/12 (17) |
LCT ICU 1/8 (13) |
LCT + MCT NR |
LCT NR |
| Lindgren 2001 | ICU patients, sepsis, multitrauma N = 30 |
C. Random: yes ITT: yes Blinding: yes (12) |
PN + Structolipid (64% LCT + 36% MCT) vs. PN + Intralipid (100% LCT, soybean) |
LCT + MCT 1/15 (7) |
LCT 0/15 (0) |
LCT + MCT 6/15 (40) |
LCT 4/15 (27) |
| Garnacho-Montero. 2002 | Surgical ICU Patients with peritonitis and abdominal sepsis N = 72 |
C. Random: not sure ITT: no Blinding: no (6) |
PN + Lipofundin (50% LCT + 50% MCT) vs. PN with Intralipid (100% LCT, soybean) Both groups received PN with 45 % Branched chain amino acids |
LCT + MCT ICU 8/35 (23) Hospital 11/35 (31) |
LCT ICU 11/37 (30) Hospital 13/37 (35) |
LCT + MCT NR |
LCT NR |
| Iovinelli 2007 | Patients with COPD requiring ventilation N = 24 |
CRandom: yes ITT: yes Blinding: no (7) |
PN + Lipofundin (50% LCT + 50% MCT) vs. 100% LCT (100% LCT, soybean). In both received 50% of non-protein calories given as lipids |
LCT + MCT ICU 2/12 (17) |
LCT ICU 3/12 (25) |
LCT + MCT Catheter- related 1/12 (8) |
LCT Catheter-related 2/12 (17) |
| Fish oil (ω 3) containing emulsions in PN fed patients vs. LCT or LCT+MCT | |||||||
| Grecu 2003 | Patients with abdominal sepsis N = 54 (15/54 in ICU) |
C. Random: yes ITT: yes Blinding: double (12) |
PN + Omegaven (10% fish oils) plus LCTs vs. PN with LCT |
Omegaven + LCT ICU 2/28 (7) |
LCT ICU 3/26 (12) |
Omegaven VAP 0/8* |
LCT VAP 1/7* (14) |
| Friesecke 2008 | Medical ICU patients N= 166 |
CRandom: yes ITT: yes Blinding: double (10) |
PN + Lipofundin MCT (50% LCT + 50% MCT) + Omegaven (10% fish oil) vs. Lipofundin MCT (50% LCT + 50% MCT) |
LCT + MCT + FO 28 day 18/83 (22) |
LCT+MCT 28 day 22/82 (27) |
LCT+ MCT+ FO 10/83 (12) |
LCT + MCT 11/82 (13) |
| Wang 2009 | Severe acute pancreatitis patients in ICU N = 56 |
C. Random: no ITT: yes Blinding: double (11) |
PN + Omegaven (10% fish oils) plus Lipovenos (LCTs, soybean oil) (ω3:ω6 ratio was 1:4) vs. PN with Lipovenos (LCTs, soybean oil). Both received same amounts of lipids (1 gm/kg/day) |
Omegaven ICU 0/28 (0) |
LCT ICU 2/28 (7) |
Omegaven 6/28 (21) |
LCT 9/28 (32) |
| Barbosa 2010 | ICU patients with SIRS or sepsis requiring PN N=25 |
CRandom: yes ITT: yes Blinding: single (10) |
PN + Lipoplus (50% MCT, 40% LCTs soybean oil, 10% FOl) vs. Nutriflex LipidSpecial (50% MCT, 50% LCT, soybean oil). Both received same amounts of lipids (~1 gm/kg/day) |
MCT+LCT+FO 5 day 2/13 (15) 28 day 4/13 (31) |
MCT+LCT 5 day 1/10 (10) 28 day 4/10 (40) |
MCT+LCT+FO NA |
MCT+LCT NA |
| Olive oil containing emulsions vs. LCT or LCT+MCT | |||||||
| Garcia-de-Lorenzo 2005 | Severe burn patients, burn severity index ≥7, TBSA > 30 % N = 22 |
C. Random: not sure ITT: yes Blinding: double (10) |
PN with ClinOleic 20% (80% olive oil, 20% soybean oil, (63% ω9, 37% ω6= restricted linoleic acid {ω6} content) vs. Lipofundin (50% LCT+ 50% MCT). |
Clinoleic ICU 4/11 (36) |
Lipofundin ICU 4/11 (36) |
Clinoleic 6/11 (55) |
Lipofundin 6/11 (55) |
| Huschak 2005** | ICU trauma patients N = 33 |
CRandom: yes ITT: yes Blinding: None (7) |
PN high fat (lipid:glucose 75:25) + Clinoleic (80% olive oil, 20% soybean oil) + EN Glucerrna (lipid:glucose 60:40) vs. PN high carbohydrate (lipid: glucose 37:63) + Lipofundin (50% LCT + 50% MCT) + EN Fresubin HP Energy (lipid:glucose 44:56) |
High fat + Clinoleic ICU 4/18 (22) |
Low fat + LCT + MCT ICU 1/15 (7) |
High fat + Clinoleic Low fat +LCT+MCT Data Not reported. |
|
| Umperrez 2012 | Medical surgical ICU pts post op (88% emergency surgeries) N =100 |
C. Random: yes ITT: yes Blinding: double (14) |
PN with ClinOleic 20% (80% olive oil, 20% soybean oil, ω6:ω3=9:1) vs. Intralipid (100% soybean oil, ω6:ω3=7:1) |
Clinoleic Hospital 5/51 (10) |
Intralipid Hospital 8/49 (16) |
Clinoleic 29/51 (57) |
Intralipid 21/49 (43) |
| Pneumonia | |||||||
| 7/51 (14) | 5/49 (10) | ||||||
| Pontes-Arruda 2012 | ICU pts requiring PN from 8 ICUs and 3 countries N=204 |
C. Random: yes ITT: yes Blinding: no (9) |
PN with ClinOleic (n=103) vs PN with a MCT/LCT based IVLE (n=101) |
ClinOleic ICU 19/103 (24) 28-day 24/103 (27) |
MCT/LCT ICU 21/101 (21) 28-day 26/101 (26) |
ClinOleic | MCT/LCT |
| All infections | |||||||
| 39/103 (38) | 35/101 (35) | ||||||
| ICU acquired infections | |||||||
| 28/103 (27) | 23/101 (23) | ||||||
| VAP/lower respiratory infections | |||||||
| 9/103 (9) | 11/101 (11) | ||||||
Abbreviations: ARDS: acute respiratory distress syndrome; C. Random: concealed randomization; DHA: docosahexaenoic acid; EN: enteral nutrition; EPA: eicosapentaenoic acid; C. Random: concealed randomization; EN: enteral nutrition; FO: fish oil; ICU: intensive care unit; ITT: intention to treat; IV: intravenous; LCT: long chain triglycerides; MCT: medium chain triglycerides; N: number of patients; NA: non attribuible; NR: non referred; PN: parenteral nutrition; SIRS: systemic inflammatory response syndrome; VAP: ventilator associated pneumonia; ω-3: omega 3; ω-6: omega 6; ω-9: omega 9.
†
hospital mortality unless specified;
‡
number of patients with infections unless specified;
*
data obtained from author, 8 out of 28 in Omegaven and 7 out of 26 in LCT group were in ICU;
**
intervention includes high fat low carbohydrates PN plus fish oil;
a
converted Standard Error Mean (SEM) to Standard deviation (SD)