title: Intravenous fish oil lipid emulsions in critically ill patients: an updated systematic review and meta-analysis.
abstract: BACKGROUND
  Intravenous fish oil (FO) lipid emulsions (LEs) are rich in ω-3 polyunsaturated fatty acids, which exhibit anti-inflammatory and immunomodulatory effects. We previously demonstrated that FO-containing LEs may be able to decrease mortality and ventilation days in patients who are critically ill. Since 2014, several additional randomized controlled trials (RCTs) of FO-containing LEs have been published. Therefore, the purpose of this systematic review was to update our previous systematic review with the aim of elucidating the efficacy of FO-containing LEs on clinical outcomes of patients who are critically ill.
  
  
  METHODS
  We searched electronic databases from 1980 to 2014. We included four new RCTs conducted in critically ill adult patients in which researchers evaluated FO-containing LEs in parenterally or enterally fed patients.
  
  
  RESULTS
  A total of 10 RCTs (n = 733) met inclusion criteria. The mean methodological score was 8 (range, 3 to 12). No effect on overall mortality was found. When we aggregated the results of five RCTs in which infections were reported, we found that FO-containing LEs significantly reduced infections (risk ratio (RR) = 0.64; 95% confidence interval (CI), 0.44 to 0.92; P = 0.02; heterogeneity I (2) = 0%). Subgroup analysis demonstrated that predominantly enteral nutrition-based trials showed a tendency toward a reduction in mortality (RR = 0.69; 95% CI, 0.40 to 1.18; P =0.18; heterogeneity I (2) =35%). High-quality trials showed a significant reduction in hospital length of stay (LOS) (weighted mean difference = -7.42; 95% CI, -11.89 to -2.94; P = 0.001), whereas low-quality trials had no effect (P = 0.45). The results of the test for subgroup differences in hospital LOS was significant (P = 0.001).
  
  
  CONCLUSIONS
  FO-containing LEs may be associated with a reduction in infections and also could be associated with a reduction in duration of ventilation and hospital LOS. Further large-scale RCTs are warranted and should be aimed at consolidating potential positive treatment effects.
authors: Intensive Care Unit, Faculty of Medicine-Universidad de la República (UdeLaR) University Hospital: Dr. Manuel Quintela, Italia Av. 14th Floor, Montevideo, 11600, Uruguay. wmanzanares@adinet.com.uy.
authors: William
authors: W
authors: Manzanares
authors: Département de Anesthésie et de Réanimation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke-Hôpital Fleurimont, Sherbrooke, PQ, Canada. Pascal.Laferriere-Langlois@USherbrooke.ca.
authors: Pascal L
authors: PL
authors: Langlois
authors: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada. dhaliwar@KGH.KARI.NET.
authors: Rupinder
authors: R
authors: Dhaliwal
authors: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada. lemieuxm@KGH.KARI.NET.
authors: Margot
authors: M
authors: Lemieux
authors: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada. dkh2@queensu.ca.|Department of Medicine, Queen's University, Kingston, ON, Canada. dkh2@queensu.ca.
authors: Daren K
authors: DK
authors: Heyland
mesh_terms: D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D005395:Fish Oils / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D010288:Parenteral Nutrition / Q000379:methods
chemical_list: D005217:Fat Emulsions, Intravenous; D005395:Fish Oils