Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials
Abstract Background Nutritional supplementation of omega-3 fatty acids has been proposed to modulate the balance of pro- and anti-inflammatory mediators in sepsis. If proved to improve clinical outcomes in critically ill patients with sepsis, this intervention would be easy to implement. However, th...
Main Authors: | , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
SpringerOpen
2017-06-01
|
Series: | Annals of Intensive Care |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s13613-017-0282-5 |
id |
doaj-1b4d430f553e400fa7940983c12a62bd |
---|---|
record_format |
Article |
spelling |
doaj-1b4d430f553e400fa7940983c12a62bd2020-11-24T20:59:27ZengSpringerOpenAnnals of Intensive Care2110-58202017-06-017111210.1186/s13613-017-0282-5Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trialsClara Lu0Sunjay Sharma1Lauralyn McIntyre2Andrew Rhodes3Laura Evans4Saleh Almenawer5Lori Leduc6Derek C. Angus7Waleed Alhazzani8Michael G. DeGroote School of Medicine, McMaster UniversityDepartment of Surgery, Division of Neurosurgery, McMaster UniversityDepartment of Medicine (Critical Care), The Ottawa Hospital Research Institute, University of OttawaDepartment of Intensive Care Medicine, St George’s HospitalDepartment of Medicine, Division of Pulmonary Medicine and Critical Care, New York UniversityDepartment of Surgery, Division of Neurosurgery, McMaster UniversitySt. Joseph’s Healthcare HamiltonDepartment of Critical Care Medicine, University of Pittsburgh School of MedicineSt. Joseph’s Healthcare HamiltonAbstract Background Nutritional supplementation of omega-3 fatty acids has been proposed to modulate the balance of pro- and anti-inflammatory mediators in sepsis. If proved to improve clinical outcomes in critically ill patients with sepsis, this intervention would be easy to implement. However, the cumulative evidence from several randomized clinical trials (RCTs) remains unclear. Methods We searched the Cochrane Library, MEDLINE, and EMBASE through December 2016 for RCTs on parenteral or enteral omega-3 supplementation in adult critically ill patients diagnosed with sepsis or septic shock. We analysed the included studies for mortality, intensive care unit (ICU) length of stay, and duration of mechanical ventilation, and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the quality of the evidence for each outcome. Results A total of 17 RCTs enrolling 1239 patients met our inclusion criteria. Omega-3 supplementation compared to no supplementation or placebo had no significant effect on mortality [relative risk (RR) 0.85; 95% confidence interval (CI) 0.71, 1.03; P = 0.10; I 2 = 0%; moderate quality], but significantly reduced ICU length of stay [mean difference (MD) −3.79 days; 95% CI −5.49, −2.09; P < 0.0001, I 2 = 82%; very low quality] and duration of mechanical ventilation (MD −2.27 days; 95% CI −4.27, −0.27; P = 0.03, I 2 = 60%; very low quality). However, sensitivity analyses challenged the robustness of these results. Conclusion Omega-3 nutritional supplementation may reduce ICU length of stay and duration of mechanical ventilation without significantly affecting mortality, but the very low quality of overall evidence is insufficient to justify the routine use of omega-3 fatty acids in the management of sepsis.http://link.springer.com/article/10.1186/s13613-017-0282-5Omega-3Fish oilPUFAEPADHANutrition |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Clara Lu Sunjay Sharma Lauralyn McIntyre Andrew Rhodes Laura Evans Saleh Almenawer Lori Leduc Derek C. Angus Waleed Alhazzani |
spellingShingle |
Clara Lu Sunjay Sharma Lauralyn McIntyre Andrew Rhodes Laura Evans Saleh Almenawer Lori Leduc Derek C. Angus Waleed Alhazzani Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials Annals of Intensive Care Omega-3 Fish oil PUFA EPA DHA Nutrition |
author_facet |
Clara Lu Sunjay Sharma Lauralyn McIntyre Andrew Rhodes Laura Evans Saleh Almenawer Lori Leduc Derek C. Angus Waleed Alhazzani |
author_sort |
Clara Lu |
title |
Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials |
title_short |
Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials |
title_full |
Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials |
title_fullStr |
Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials |
title_full_unstemmed |
Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials |
title_sort |
omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials |
publisher |
SpringerOpen |
series |
Annals of Intensive Care |
issn |
2110-5820 |
publishDate |
2017-06-01 |
description |
Abstract Background Nutritional supplementation of omega-3 fatty acids has been proposed to modulate the balance of pro- and anti-inflammatory mediators in sepsis. If proved to improve clinical outcomes in critically ill patients with sepsis, this intervention would be easy to implement. However, the cumulative evidence from several randomized clinical trials (RCTs) remains unclear. Methods We searched the Cochrane Library, MEDLINE, and EMBASE through December 2016 for RCTs on parenteral or enteral omega-3 supplementation in adult critically ill patients diagnosed with sepsis or septic shock. We analysed the included studies for mortality, intensive care unit (ICU) length of stay, and duration of mechanical ventilation, and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the quality of the evidence for each outcome. Results A total of 17 RCTs enrolling 1239 patients met our inclusion criteria. Omega-3 supplementation compared to no supplementation or placebo had no significant effect on mortality [relative risk (RR) 0.85; 95% confidence interval (CI) 0.71, 1.03; P = 0.10; I 2 = 0%; moderate quality], but significantly reduced ICU length of stay [mean difference (MD) −3.79 days; 95% CI −5.49, −2.09; P < 0.0001, I 2 = 82%; very low quality] and duration of mechanical ventilation (MD −2.27 days; 95% CI −4.27, −0.27; P = 0.03, I 2 = 60%; very low quality). However, sensitivity analyses challenged the robustness of these results. Conclusion Omega-3 nutritional supplementation may reduce ICU length of stay and duration of mechanical ventilation without significantly affecting mortality, but the very low quality of overall evidence is insufficient to justify the routine use of omega-3 fatty acids in the management of sepsis. |
topic |
Omega-3 Fish oil PUFA EPA DHA Nutrition |
url |
http://link.springer.com/article/10.1186/s13613-017-0282-5 |
work_keys_str_mv |
AT claralu omega3supplementationinpatientswithsepsisasystematicreviewandmetaanalysisofrandomizedtrials AT sunjaysharma omega3supplementationinpatientswithsepsisasystematicreviewandmetaanalysisofrandomizedtrials AT lauralynmcintyre omega3supplementationinpatientswithsepsisasystematicreviewandmetaanalysisofrandomizedtrials AT andrewrhodes omega3supplementationinpatientswithsepsisasystematicreviewandmetaanalysisofrandomizedtrials AT lauraevans omega3supplementationinpatientswithsepsisasystematicreviewandmetaanalysisofrandomizedtrials AT salehalmenawer omega3supplementationinpatientswithsepsisasystematicreviewandmetaanalysisofrandomizedtrials AT lorileduc omega3supplementationinpatientswithsepsisasystematicreviewandmetaanalysisofrandomizedtrials AT derekcangus omega3supplementationinpatientswithsepsisasystematicreviewandmetaanalysisofrandomizedtrials AT waleedalhazzani omega3supplementationinpatientswithsepsisasystematicreviewandmetaanalysisofrandomizedtrials |
_version_ |
1716782322322243584 |