gamma-linolenic-acid and Shock--Septic

Enteral diets enriched with eicosapentaenoic acid (EPA), gamma-linolenic acid (GLA), and antioxidants have previously been shown to improve outcomes in patients with acute respiratory distress syndrome. Several studies using animal models of sepsis demonstrate that enteral nutrition enriched with omega-3 fatty acids reduces mortality rate. This study investigated whether an enteral diet enriched with EPA, GLA, and antioxidant vitamins can improve outcomes and reduce 28-day all-cause mortality in patients with severe sepsis or septic shock requiring mechanical ventilation.. Prospective, double-blind, placebo-controlled, randomized trial.. Three different intensive care units of a tertiary hospital in Brazil.. The study enrolled 165 patients.. Patients were randomized to be continuously tube-fed with either a diet enriched with EPA, GLA, and elevated antioxidants or an isonitrogenous and isocaloric control diet, delivered at a constant rate to achieve a minimum of 75% of basal energy expenditure x 1.3 during a minimum of 4 days.. Patients were monitored for 28 days. Patients who were fed with the study diet experienced a significant reduction in mortality rate compared with patients fed with the control diet, the absolute mortality reduction amounting to 19.4% (p = .037). The group who received the study diet also experienced significant improvements in oxygenation status, more ventilator-free days (13.4 +/- 1.2 vs. 5.8 +/- 1.0, p < .001), more intensive care unit (ICU)-free days (10.8 +/- 1.1 vs. 4.6 +/- 0.9, p < .001), and a lesser development of new organ dysfunctions (p < .001).. In patients with severe sepsis or septic shock and requiring mechanical ventilation and tolerating enteral nutrition, a diet enriched with EPA, GLA, and elevated antioxidants contributed to better ICU and hospital outcomes and was associated with lower mortality rates.

Topics: Aged; Antioxidants; Ascorbic Acid; Brazil; Double-Blind Method; Eicosapentaenoic Acid; Enteral Nutrition; Female; gamma-Linolenic Acid; Humans; Intensive Care Units; Length of Stay; Male; Middle Aged; Multiple Organ Failure; Prospective Studies; Pulmonary Gas Exchange; Respiration, Artificial; Respiratory Distress Syndrome; Sepsis; Shock, Septic; Vitamin E

Topics: Antioxidants; Critical Care; Eicosapentaenoic Acid; Enteral Nutrition; gamma-Linolenic Acid; Hospital Mortality; Humans; Respiration, Artificial; Shock, Septic; Survival Rate; Systemic Inflammatory Response Syndrome

Topics: Antioxidants; Critical Care; Eicosapentaenoic Acid; Enteral Nutrition; gamma-Linolenic Acid; Hospital Mortality; Humans; Nutritional Status; Respiration, Artificial; Respiratory Distress Syndrome; Shock, Septic; Survival Rate; Systemic Inflammatory Response Syndrome

Topics: Antioxidants; Eicosapentaenoic Acid; Enteral Nutrition; gamma-Linolenic Acid; Humans; Intensive Care Units; Multiple Organ Failure; Pulmonary Gas Exchange; Respiratory Distress Syndrome; Sepsis; Shock, Septic

The influence on the metabolic response to endotoxin of three days of total parenteral nutrition with lipids high in gammalinolenic acid (18:3 omega 6, GLA) compared to soy oil (SO) was examined in acute operatively stressed guinea pigs. GLA is the precursor of dihomogammalinolenic acid (DHLA), the substrate for synthesis of "1" series prostaglandins such as PGE1, which have previously been shown to be protective in endotoxin lung injury and traumatic shock. Guinea pigs fed an intravenous diet containing black currant seed oil (BCO) emulsion (20% GLA) or soy oil emulsion (0% GLA) for 2.5 days had their arterial pH, pCO2, pO2, and bicarbonate measured at baseline and hourly during a 7-hr infusion of endotoxin (lipopolysaccharide (LPS), 2mg/kg) or saline. Plasma lactate and fatty acid profile analyses were performed at the end of the LPS infusion. Increased levels of GLA and DHLA were present in the plasma phospholipid fraction of animals fed the black currant seed oil diet, while soy-fed animals had only trace amounts of GLA. In addition, the ratio of DHLA to arachidonate was higher in animals receiving the black currant seed oil total parenteral nutrition (TPN). After 2 hr of LPS infusion, all animals exhibited the typical shock response resulting in metabolic acidosis characterized by a significant (p less than 0.05) drop in pH from 7.34 +/- .02 (SO) and 7.39 +/- .02 (BCO) at baseline to 7.14 +/- .05 and 7.22 +/- .04 by 7 hr for SO and BCO groups, respectively. Plasma lactate values at the end of the infusion were significantly elevated compared to saline in both groups (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: 8,11,14-Eicosatrienoic Acid; Animals; Bicarbonates; Blood; Dietary Fats, Unsaturated; Endotoxins; Fatty Acids; gamma-Linolenic Acid; Guinea Pigs; Hydrogen-Ion Concentration; Lactates; Lactic Acid; Linolenic Acids; Male; Parenteral Nutrition, Total; Shock, Septic