Omega-3 Fatty Acids in Patients with Sepsis: A Systematic Review and Meta-analysis
CCCF ePoster library. Lu C. Nov 1, 2016; 150970; 89
Clara Lu
Clara Lu
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Topic: Systematic Review, Meta-analysis, or Meta-synthesis

Omega-3 Fatty Acids in Patients with Sepsis: A Systematic Review and Meta-analysis


Lu, Clara1; Sharma, Sunjay2; McIntyre, Lauralyn3; Rhodes, Andrew4; Evans, Laura5; Almenawer, Saleh2,6; Angus, Derek C7; Alhazzani, Waleed6,8 

1
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
2
Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Canada
3
Department of Medicine (Critical Care), The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
4
Department of Intensive Care Medicine, St George's Hospital, London, UK
5
Department of Medicine, Division of Pulmonary Medicine and Critical Care, New York University, New York City, USA
6
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
7
Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
8
Department of Medicine, McMaster University, Hamilton, Canada



Abstract:

Introduction
Nutritional supplementation of omega-3 fatty acids has been proposed to improve clinical outcomes in critically ill patients with sepsis, but the cumulative evidence from several randomized controlled trials (RCTs) remains unclear.
 
Objectives
This systematic review and meta-analysis synthesizes RCTs comparing omega-3 nutritional supplementation to no supplementation or placebo in critically ill, septic patients. It presents a comprehensive evaluation of the effects of omega-3 fatty acids on mortality, intensive care unit (ICU) length of stay, and duration of mechanical ventilation.
 
Methods
We searched the Cochrane Library, MEDLINE, and EMBASE through August 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, ICU length of stay, and duration of mechanical ventilation, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of the evidence for each outcome.
 
Results
A total of 16 RCTs enrolling 1216 patients met inclusion criteria. Omega-3 supplementation compared to no supplementation or placebo had no significant effect on mortality (relative risk [RR] 0.86; 95% CI 0.71, 1.03; P = 0.11; = 0%; low quality), but significantly reduced ICU length of stay (mean difference [MD] -3.84 days; 95% CI -5.57, -2.12; P < 0.0001,= 84%; very low quality) and duration of mechanical ventilation (MD -2.33 days; 95% CI -4.44, -0.22; P = 0.03, = 67%; very low quality). However, the significance of reduced duration of mechanical ventilation was challenged by sensitivity analyses excluding studies published in abstract form (P = 0.08) and studies that did not stratify mechanically ventilated patients during randomization (P = 0.22).

Conclusion
Omega-3 nutritional supplementation may reduce ICU length of stay and duration of mechanical ventilation without significantly affecting mortality, but the low to very low quality of existing evidence is insufficient to justify the routine use of omega-3 fatty acids in the management of sepsis.


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