Fish oil in critical illness.
OBJECTIVE
The aim of this review is to discuss recent advances in the role of n-3 lipids derived from fish oil in clinical nutrition in an intensive care setting.


RESULTS
Fish oil supplies n-3 fatty acids which compete with arachidonic acid (n-6) for the conversion to lipid mediators, influence lipid-bound second messenger generation and dependent cellular functions, and are a source for resolvins necessary for the resolution of inflammation. Enteral nutrition with n-3 fatty acids improved ventilation time in patients with acute lung injury and in one study reduced mortality in septic patients. Using a high-dose short-term infusion of fish oil-based lipid emulsion, rapid immunologic changes and effects on the endotoxin-induced stress response may be achieved. Inclusion of n-3 fatty acids in parenteral nutrition improved immunologic parameters and length of stay in surgical patients.


CONCLUSIONS
Inclusion of fish oil in nutrition may influence the immune response and clinical outcomes by balancing the negative effects of n-6 fatty acids. Application as a part of enteral immunonutrition in surgical or acute respiratory distress syndrome patients and in lipid emulsions in surgical patients has beneficial effects. In septic patients, data on enteral use are highly controversial. Prospective data from randomized trials, however, are lacking.
Mayer
Konstantin
K
Department of Internal Medicine, Pulmonary and Critical Care Medicine, Justus Liebig University Giessen, Germany. konstantin.mayer@innere.med.uni-giessen.de
Seeger
Werner
W
D002986:Clinical Trials as Topic; D003422:Critical Care / Q000379:methods* / Q000592:standards; D016638:Critical Illness / Q000628:therapy*; D004750:Enteral Nutrition; D019317:Evidence-Based Medicine; D015525:Fatty Acids, Omega-3 / Q000276:immunology* / Q000627:therapeutic use*; D005395:Fish Oils / Q000737:chemistry*; D006801:Humans; D010288:Parenteral Nutrition; D016896:Treatment Outcome
D015525:Fatty Acids, Omega-3; D005395:Fish Oils