Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ARDS Study Group
Gadek JE, DeMichele SJ, Karlstad MD, Pacht ER, Donahoe M, Albertson TE, Van Hoozen C, Wennberg AK, Nelson JL, Noursalehi M
Critical care medicine · 393 citas
Etiquetas de revisión
Financiación no declaradaDatos neutrales que nuestra revisión registró sobre cómo se hizo este estudio. Describen el método, nunca si nos gusta el resultado.
Cómo se estudió
- Diseño
- Ensayo controlado aleatorizado (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 1999-08-01 · Crit Care Med · vol. 27 · número 8 · págs. 1409–1420
- Editorial
- Lippincott Williams & Wilkins
- Citado
- 760 citas · más que el 100% de estudios similares · 27.3× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 53 trabajos
- Acceso
- De pago
- Áreas de investigación
- Respiratory Support and Mechanisms · Clinical Nutrition and Gastroenterology · Fatty Acid Research and Health
- Palabras clave
- acute respiratory distress syndrome, enteral nutrition, eicosapentaenoic acid, gamma-linolenic acid, fish oil, borage oil, antioxidants, omega-3 fatty acids, bronchoalveolar lavage, oxygenation, PaO2/FiO2 ratio, mechanical ventilation, sepsis, pneumonia, trauma (physical injury), aspiration injury, lung inflammation
- MeSH
- neutrophils, bronchoalveolar lavage fluid, humans, inflammation, eicosapentaenoic acid, gamma-linolenic acid, antioxidants, blood gas analysis, pulmonary gas exchange, pulmonary ventilation, leukocyte count, respiration, artificial, enteral nutrition, length of stay, prospective studies, double-blind method, middle aged, female, male, respiratory distress syndrome
10 autores
- James E. Gadek🇺🇸The Ohio State University Wexner Medical Center; The Ohio State University
- Stephen J. DeMichele🇺🇸Mayo Clinic; University of Pittsburgh; University of Tennessee Medical Center; The Ohio State University Wexner Medical Center; Abbott (United States); University of Pittsburgh Medical Center; University of California Davis Medical Center; The Ohio State University; University of Tennessee at Knoxville; University of California, Davis
- Michael D. Karlstad🇺🇸Mayo Clinic; University of Pittsburgh; University of Tennessee Medical Center; The Ohio State University Wexner Medical Center; University of Pittsburgh Medical Center; University of California Davis Medical Center; The Ohio State University; University of Tennessee at Knoxville; University of California, Davis
- Eric R. Pacht🇺🇸Mayo Clinic; University of Pittsburgh; University of Tennessee Medical Center; The Ohio State University Wexner Medical Center; University of Pittsburgh Medical Center; University of California Davis Medical Center; The Ohio State University; University of Tennessee at Knoxville; University of California, Davis
- Michael P. Donahoe🇺🇸Mayo Clinic; University of Pittsburgh; University of Tennessee Medical Center; The Ohio State University Wexner Medical Center; University of Pittsburgh Medical Center; University of California Davis Medical Center; The Ohio State University; University of Tennessee at Knoxville; University of California, Davis
- Timothy E. Albertson🇺🇸Mayo Clinic; University of Pittsburgh; University of Tennessee Medical Center; The Ohio State University Wexner Medical Center; University of Pittsburgh Medical Center; University of California Davis Medical Center; The Ohio State University; University of Tennessee at Knoxville; University of California, Davis
- Chi Van Hoozen🇺🇸Mayo Clinic; University of California, Davis
- Ann K. Wennberg🇺🇸Mayo Clinic; University of Pittsburgh; University of Tennessee Medical Center; The Ohio State University Wexner Medical Center; Abbott (United States); University of Pittsburgh Medical Center; University of California Davis Medical Center; The Ohio State University; University of Tennessee at Knoxville; University of California, Davis
- Jeffrey L. Nelson🇺🇸Mayo Clinic; University of Pittsburgh; University of Tennessee Medical Center; The Ohio State University Wexner Medical Center; Abbott (United States); University of Pittsburgh Medical Center; University of California Davis Medical Center; The Ohio State University; University of Tennessee at Knoxville; University of California, Davis
- Mojtaba Noursalehi🇺🇸Mayo Clinic; University of Pittsburgh; University of Tennessee Medical Center; The Ohio State University Wexner Medical Center; University of Pittsburgh Medical Center; University of California Davis Medical Center; The Ohio State University; University of Tennessee at Knoxville; University of California, Davis
Resumen
El texto original del estudio, en el idioma en que se publicó.
Objectives
Recent studies in animal models of sepsis-induced acute respiratory distress syndrome (ARDS) have shown that a low-carbohydrate, high-fat diet combining the anti-inflammatory and vasodilatory properties of eicosapentaenoic acid (EPA; fish oil), gamma-linolenic acid (GLA; borage oil) (EPA+GLA), and antioxidants improves lung microvascular permeability, oxygenation, and cardiopulmonary function and reduces proinflammatory eicosanoid synthesis and lung inflammation. These findings suggest that enteral nutrition with EPA+GLA and antioxidants may reduce pulmonary inflammation and may improve oxygenation and clinical outcomes in patients with ARDS.
Design
Prospective, multicentered, double-blind, randomized controlled trial.
Setting
Intensive care units of five academic and teaching hospitals in the United States.
Patients
We enrolled 146 patients with ARDS (as defined by the American-European Consensus Conference) caused by sepsis/pneumonia, trauma, or aspiration injury in the study.
Interventions
Patients meeting entry criteria were randomized and continuously tube-fed either EPA+GLA or an isonitrogenous, isocaloric standard diet at a minimum caloric delivery of 75% of basal energy expenditure x 1.3 for at least 4-7 days.
Measurements and main results
Arterial blood gases were measured, and ventilator settings were recorded at baseline and study days 4 and 7 to enable calculation of PaO2/FIO2, a measure of gas exchange. Pulmonary neutrophil recruitment was assessed by measuring the number of neutrophils and the total cell count in bronchoalveolar lavage fluid at the same time points. Clinical outcomes were recorded. Baseline characteristics of 98 evaluable patients revealed that key demographic, physiologic, and ventilatory variables were similar at entry between both groups. Multiple bronchoalveolar lavages revealed significant decreases (approximately 2.5-fold) in the number of total cells and neutrophils per mL of recovered lavage fluid during the study with EPA+GLA compared with patients fed the control diet. Significant improvements in oxygenation (PaO2/FIO2) from baseline to study days 4 and 7 with lower ventilation variables (FIO2, positive end-expiratory pressure, and minute ventilation) occurred in patients fed EPA+GLA compared with controls. Patients fed EPA+GLA required significantly fewer days of ventilatory support (11 vs. 16.3 days; p = .011), and had a decreased length of stay in the intensive care unit (12.8 vs. 17.5 days; p = .016) compared with controls. Only four of 51 (8%) patients fed EPA+GLA vs. 13 of 47 (28%) control patients developed a new organ failure during the study (p = .015).
Conclusions
The beneficial effects of the EPA+GLA diet on pulmonary neutrophil recruitment, gas exchange, requirement for mechanical ventilation, length of intensive care unit stay, and the reduction of new organ failures suggest that this enteral nutrition formula would be a useful adjuvant therapy in the clinical management of patients with or at risk of developing ARDS.
Resumen vía Europe PMC. Los derechos de autor siguen siendo de los autores o la editorial.
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