title: Modulation of Dietary Lipid Composition During Acute Respiratory Distress Syndrome: Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Pharmaconutrition including omega-3 and competitive analogs of omega-6 fatty acids has been used to modulate the inflammatory response during acute respiratory distress syndrome (ARDS). The clinical benefit of this approach when assessed in prospective randomized clinical trials has been inconsistent. We tried to assess the reasons for the conflicting results, including the possible influence of the composition of the control solution.
  
  
  METHODS
  We collected data from studies listed in PubMed, Ovid, the Cochrane Database of Systematic Reviews, Embase, the U.S. National Institute of Health database, and the ARDSnet database up to March 2013. We included all trials that evaluated effects of enteral pharmaconutrition vs a control solution on mortality, ventilator-free days, length of stay (LOS) in the intensive care unit (ICU), and ICU-free days. A sensitivity analysis was carried out to study the influence of the lipid content of the control solution.
  
  
  RESULTS
  We found 7 eligible studies (802 patients; 405 randomized to pharmaconutrition). The aggregated results showed no overall effect on mortality (risk ratio [RR] = 0.83 [0.55-1.25], P = .37), but there was a mortality benefit when only studies in which pharmaconutrition was compared to a lipid-rich control solution were considered (RR = 0.57 [0.41-0.78], P < .001). ICU LOS was shorter in patients randomized to pharmaconutrition (RR = 0.5 [0.85-0.16]).
  
  
  CONCLUSIONS
  Use of enteral pharmaconutrition in patients with ARDS was associated with decreased mortality only when the comparator solution contained a greater amount of lipid than is currently recommended. Hence, there is insufficient evidence to support the use of enteral pharmaconutrition in ARDS.
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium carandres74@yahoo.com.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Santacruz
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium.
authors.forename: Diego
authors.initials: D
authors.lastname: Orbegozo
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium.
authors.forename: Jean Charles
authors.initials: JC
authors.lastname: Preiser
mesh_terms: D004041:Dietary Fats / Q000008:administration & dosage*; D004750:Enteral Nutrition; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D043371:Fatty Acids, Omega-6 / Q000008:administration & dosage; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D057947:Parenteral Nutrition Solutions / Q000737:chemistry*; D016032:Randomized Controlled Trials as Topic; D012128:Respiratory Distress Syndrome / Q000178:diet therapy* / Q000401:mortality
chemical_list: D004041:Dietary Fats; D015525:Fatty Acids, Omega-3; D043371:Fatty Acids, Omega-6; D057947:Parenteral Nutrition Solutions
keywords: critically ill; mechanical ventilation; meta-analysis; mortality; ω-3 fatty acids