title: Three short perioperative infusions of n-3 PUFAs reduce systemic inflammation induced by cardiopulmonary bypass surgery: a randomized controlled trial.
abstract: BACKGROUND
  Fish oil (FO) has antiinflammatory effects, which might reduce systemic inflammation induced by a cardiopulmonary bypass (CPB).
  
  
  OBJECTIVE
  We tested whether perioperative infusions of FO modify the cell membrane composition, inflammatory responses, and clinical course of patients undergoing elective coronary artery bypass surgery.
  
  
  METHODS
  A prospective randomized controlled trial was conducted in cardiac surgery patients who received 3 infusions of 0.2 g/kg FO emulsion or saline (control) 12 and 2 h before and immediately after surgery. Blood samples (7 time points) and an atrial biopsy (during surgery) were obtained to assess the membrane incorporation of PUFAs. Hemodynamic data, catecholamine requirements, and core temperatures were recorded at 10-min intervals; blood triglycerides, nonesterified fatty acids, glucose, lactate, inflammatory cytokines, and carboxyhemoglobin concentrations were measured at selected time points.
  
  
  RESULTS
  Twenty-eight patients, with a mean ± SD age of 65.5 ± 9.9 y, were enrolled with no baseline differences between groups. Significant increases in platelet EPA (+0.86%; P = 0.0001) and DHA (+0.87%; P = 0.019) were observed after FO consumption compared with at baseline. Atrial tissue EPA concentrations were higher after FO than after control treatments (+0.5%; P < 0.0001). FO did not significantly alter core temperature but decreased the postoperative rise in IL-6 (P = 0.018). Plasma triglycerides increased transiently after each FO infusion. Plasma concentrations of glucose, lactate, and blood carboxyhemoglobin were lower in the FO than in the control group on the day after surgery. Arrhythmia incidence was low with no significant difference between groups. No adverse effect of FO was detected.
  
  
  CONCLUSIONS
  Perioperative FO infusions significantly increased PUFA concentrations in platelet and atrial tissue membranes within 12 h of the first FO administration and decreased biological and clinical signs of inflammation. These results suggest that perioperative FO may be beneficial in elective cardiac surgery with CPB.
authors.affiliation: Services of Adult Intensive Care Medicine and Burns, Lausanne University Hospital, Lausanne, Switzerland. mette.merger@chuv.ch
authors.forename: Mette M
authors.initials: MM
authors.lastname: Berger
authors.forename: Frederik
authors.initials: F
authors.lastname: Delodder
authors.forename: Lucas
authors.initials: L
authors.lastname: Liaudet
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Tozzi
authors.forename: Juerg
authors.initials: J
authors.lastname: Schlaepfer
authors.forename: René L
authors.initials: RL
authors.lastname: Chiolero
authors.forename: Luc
authors.initials: L
authors.lastname: Tappy
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects / Q000378:metabolism / Q000627:therapeutic use; D001792:Blood Platelets / Q000276:immunology / Q000378:metabolism; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002462:Cell Membrane / Q000378:metabolism; D015331:Cohort Studies; D004311:Double-Blind Method; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects / Q000378:metabolism / Q000627:therapeutic use; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage* / Q000009:adverse effects / Q000378:metabolism / Q000627:therapeutic use; D005395:Fish Oils / Q000008:administration & dosage; D005500:Follow-Up Studies; D006325:Heart Atria / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D006331:Heart Diseases / Q000150:complications / Q000276:immunology / Q000601:surgery; D006785:Hospitals, University; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000009:adverse effects; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005217:Fat Emulsions, Intravenous; D015525:Fatty Acids, Omega-3; D005395:Fish Oils