Intravenous fish oil in critically ill and surgical patients - Historical remarks and critical appraisal

K Georg Kreymann; Daren K Heyland; Geraldine de Heer; Gunnar Elke

doi:10.1016/j.clnu.2017.07.006

Intravenous fish oil in critically ill and surgical patients - Historical remarks and critical appraisal

Standard

Intravenous fish oil in critically ill and surgical patients - Historical remarks and critical appraisal. / Kreymann, K Georg; Heyland, Daren K; de Heer, Geraldine; Elke, Gunnar.

In: CLIN NUTR, Vol. 37, No. 3, 06.2018, p. 1075-1081.

Research output: SCORING: Contribution to journal › SCORING: Review article › Research

Harvard

Kreymann, KG, Heyland, DK, de Heer, G & Elke, G 2018, 'Intravenous fish oil in critically ill and surgical patients - Historical remarks and critical appraisal', CLIN NUTR, vol. 37, no. 3, pp. 1075-1081. https://doi.org/10.1016/j.clnu.2017.07.006

APA

Kreymann, K. G., Heyland, D. K., de Heer, G., & Elke, G. (2018). Intravenous fish oil in critically ill and surgical patients - Historical remarks and critical appraisal. CLIN NUTR, 37(3), 1075-1081. https://doi.org/10.1016/j.clnu.2017.07.006

Vancouver

Kreymann KG, Heyland DK, de Heer G, Elke G. Intravenous fish oil in critically ill and surgical patients - Historical remarks and critical appraisal. CLIN NUTR. 2018 Jun;37(3):1075-1081. https://doi.org/10.1016/j.clnu.2017.07.006

Bibtex

@article{873f08b4745347db922a3da7c1174dd3,

title = "Intravenous fish oil in critically ill and surgical patients - Historical remarks and critical appraisal",

abstract = "The purpose of this review is to explain the historical and clinical background for intravenous fish oil administration, to evaluate its results by using a product specific metaanalysis, and to stimulate further research in the immune-modulatory potential of fish oil. Concerning the immune-modulatory effects of fatty acids, a study revealed that ω-3 as well as ω-6 fatty acids would prolong transplant survival, and only a mixture with an ω-6:ω-3 ratio of 2.1:1 would give immune-neutral results. In 1998, the label of a newly registered fish oil emulsion also acknowledged this immune-neutral ratio in conjunction with ω-6 lipids. Also, two fish oil-supplemented fat emulsions, registered in 2004, used a similar ω-6:ω-3 ratio. Such an immune-neutral ω-6:ω-3 ratio denoted progress for most patients compared to pure ω-6 lipid emulsions. However, this immune-neutrality might on the other hand be responsible for the limited positive clinical results gained so far in critically ill and surgical patients where in most cases significance could only be shown for the pooled effect of numerous trials. Our product specific metaanalysis also did not reveal any differences, neither in infections rates nor in ICU or hospital length of stay. To evaluate the immune-modulatory effect of fish oil administered alone, new dose finding studies, reporting relevant clinical outcome parameters, are required. Precise mechanistic or physiological biomarkers for the indication of such a therapy should also be developed and validated.",

keywords = "Journal Article, Surgical Procedures, Operative, Humans, Critical Illness, Fatty Acids, Omega-3/immunology, Fat Emulsions, Intravenous/administration & dosage, Critical Care/methods, Administration, Intravenous, Fish Oils, Postoperative Complications/immunology, Parenteral Nutrition/methods, Fatty Acids, Omega-6/immunology, Immunologic Factors/administration & dosage",

author = "Kreymann, {K Georg} and Heyland, {Daren K} and {de Heer}, Geraldine and Gunnar Elke",

year = "2018",

month = jun,

doi = "10.1016/j.clnu.2017.07.006",

language = "English",

volume = "37",

pages = "1075--1081",

journal = "CLIN NUTR",

issn = "0261-5614",

publisher = "Churchill Livingstone",

number = "3",

}

RIS

TY - JOUR

T1 - Intravenous fish oil in critically ill and surgical patients - Historical remarks and critical appraisal

AU - Kreymann, K Georg

AU - Heyland, Daren K

AU - de Heer, Geraldine

AU - Elke, Gunnar

PY - 2018/6

Y1 - 2018/6

N2 - The purpose of this review is to explain the historical and clinical background for intravenous fish oil administration, to evaluate its results by using a product specific metaanalysis, and to stimulate further research in the immune-modulatory potential of fish oil. Concerning the immune-modulatory effects of fatty acids, a study revealed that ω-3 as well as ω-6 fatty acids would prolong transplant survival, and only a mixture with an ω-6:ω-3 ratio of 2.1:1 would give immune-neutral results. In 1998, the label of a newly registered fish oil emulsion also acknowledged this immune-neutral ratio in conjunction with ω-6 lipids. Also, two fish oil-supplemented fat emulsions, registered in 2004, used a similar ω-6:ω-3 ratio. Such an immune-neutral ω-6:ω-3 ratio denoted progress for most patients compared to pure ω-6 lipid emulsions. However, this immune-neutrality might on the other hand be responsible for the limited positive clinical results gained so far in critically ill and surgical patients where in most cases significance could only be shown for the pooled effect of numerous trials. Our product specific metaanalysis also did not reveal any differences, neither in infections rates nor in ICU or hospital length of stay. To evaluate the immune-modulatory effect of fish oil administered alone, new dose finding studies, reporting relevant clinical outcome parameters, are required. Precise mechanistic or physiological biomarkers for the indication of such a therapy should also be developed and validated.

AB - The purpose of this review is to explain the historical and clinical background for intravenous fish oil administration, to evaluate its results by using a product specific metaanalysis, and to stimulate further research in the immune-modulatory potential of fish oil. Concerning the immune-modulatory effects of fatty acids, a study revealed that ω-3 as well as ω-6 fatty acids would prolong transplant survival, and only a mixture with an ω-6:ω-3 ratio of 2.1:1 would give immune-neutral results. In 1998, the label of a newly registered fish oil emulsion also acknowledged this immune-neutral ratio in conjunction with ω-6 lipids. Also, two fish oil-supplemented fat emulsions, registered in 2004, used a similar ω-6:ω-3 ratio. Such an immune-neutral ω-6:ω-3 ratio denoted progress for most patients compared to pure ω-6 lipid emulsions. However, this immune-neutrality might on the other hand be responsible for the limited positive clinical results gained so far in critically ill and surgical patients where in most cases significance could only be shown for the pooled effect of numerous trials. Our product specific metaanalysis also did not reveal any differences, neither in infections rates nor in ICU or hospital length of stay. To evaluate the immune-modulatory effect of fish oil administered alone, new dose finding studies, reporting relevant clinical outcome parameters, are required. Precise mechanistic or physiological biomarkers for the indication of such a therapy should also be developed and validated.

KW - Journal Article

KW - Surgical Procedures, Operative

KW - Humans

KW - Critical Illness

KW - Fatty Acids, Omega-3/immunology

KW - Fat Emulsions, Intravenous/administration & dosage

KW - Critical Care/methods

KW - Administration, Intravenous

KW - Fish Oils

KW - Postoperative Complications/immunology

KW - Parenteral Nutrition/methods

KW - Fatty Acids, Omega-6/immunology

KW - Immunologic Factors/administration & dosage

U2 - 10.1016/j.clnu.2017.07.006

DO - 10.1016/j.clnu.2017.07.006

M3 - SCORING: Review article

C2 - 28747247

VL - 37

SP - 1075

EP - 1081

JO - CLIN NUTR

JF - CLIN NUTR

SN - 0261-5614

IS - 3

ER -