Lipid emulsions in parenteral nutrition of intensive care patients: current thinking and future directions.
BACKGROUND
Energy deficit is a common and serious problem in intensive care units and is associated with increased rates of complications, length of stay, and mortality. Parenteral nutrition (PN), either alone or in combination with enteral nutrition, can improve nutrient delivery to critically ill patients. Lipids provide a key source of calories within PN formulations, preventing or correcting energy deficits and improving outcomes.


CONCLUSIONS
In this article, we review the role of parenteral lipid emulsions (LEs) in the management of critically ill patients and highlight important biologic activities associated with lipids. Soybean-oil-based LEs with high contents of polyunsaturated fatty acids (PUFA) were the first widely used formulations in the intensive care setting. However, they may be associated with increased rates of infection and lipid peroxidation, which can exacerbate oxidative stress. More recently developed parenteral LEs employ partial substitution of soybean oil with oils providing medium-chain triglycerides, omega-9 monounsaturated fatty acids or omega-3 PUFA. Many of these LEs have demonstrated reduced effects on oxidative stress, immune responses, and inflammation. However, the effects of these LEs on clinical outcomes have not been extensively evaluated.


CONCLUSIONS
Ongoing research using adequately designed and well-controlled studies that characterize the biologic properties of LEs should assist clinicians in selecting LEs within the critical care setting. Prescription of PN containing LEs should be based on available clinical data, while considering the individual patient's physiologic profile and therapeutic requirements.
Calder
Philip C
PC
Institute of Human Nutrition, University of Southampton, Southampton, UK. pcc@soton.ac.uk
Jensen
Gordon L
GL
Koletzko
Berthold V
BV
Singer
Pierre
P
Wanten
Geert J A
GJ
D016638:Critical Illness / Q000628:therapy*; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage*; D005544:Forecasting; D006801:Humans; D007362:Intensive Care Units; D010288:Parenteral Nutrition / Q000379:methods* / Q000639:trends
D005217:Fat Emulsions, Intravenous