Immunonutrition for Adults With ARDS: Results From a Cochrane Systematic Review and Meta-Analysis.
acute respiratory distress syndrome
immunonutrition
omega-3 fatty acids
Journal
Respiratory care
ISSN: 1943-3654
Titre abrégé: Respir Care
Pays: United States
ID NLM: 7510357
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
pubmed:
12
9
2019
medline:
26
11
2020
entrez:
12
9
2019
Statut:
ppublish
Résumé
ARDS is an overwhelming systemic inflammatory process associated with significant morbidity and mortality. Several trials have evaluated the effects of pharmaconutrients, given as part of a feeding formula or as a nutritional supplement, on clinical outcomes in critical illness and ARDS. The aim of this review is to assess the effects of immunonutrition on mechanically ventilated adults with ARDS compared to the standard feeding formula. We searched MEDLINE, EMBASE, CENTRAL, conference proceedings, and trial registries for appropriate studies up to April 2018. We performed statistical analysis according to Cochrane methodological standards. We used the GRADE approach to assess the quality of evidence for each outcome. We identified 10 randomized controlled trials with 1,015 participants. All of the studies compared an enteral formula or additional supplemental omega-3 fatty acids (eg, eicosapentaenoic acid, docosahexaenoic acid), γ-linolenic acid, and antioxidants. All of the studies reported mortality. For the primary outcome, there was no difference in all-cause mortality (for the longest period reported) with the use of an immunonutrition enteral formula or additional supplements of omega-3 fatty acids, γ-linolenic acid, and antioxidants (risk ratio = 0.79, 95% CI 0.59-1.07; low-quality evidence). For the secondary outcomes, we are uncertain whether immunonutrition with omega-3 fatty acids and antioxidants improves ICU length of stay, ventilator days, and oxygenation or increases harm. This Cochrane meta-analysis of 10 studies of varying quality examined the effects of omega-3 fatty acids and antioxidants in adults with ARDS. This intervention may produce little or no difference in all-cause mortality between groups. We are uncertain whether immunonutrition with omega-3 fatty acids and antioxidants improves ventilator days, ICU length of stay, or oxygenation due to the very low quality of evidence.
Sections du résumé
BACKGROUND
BACKGROUND
ARDS is an overwhelming systemic inflammatory process associated with significant morbidity and mortality. Several trials have evaluated the effects of pharmaconutrients, given as part of a feeding formula or as a nutritional supplement, on clinical outcomes in critical illness and ARDS. The aim of this review is to assess the effects of immunonutrition on mechanically ventilated adults with ARDS compared to the standard feeding formula.
METHODS
METHODS
We searched MEDLINE, EMBASE, CENTRAL, conference proceedings, and trial registries for appropriate studies up to April 2018. We performed statistical analysis according to Cochrane methodological standards. We used the GRADE approach to assess the quality of evidence for each outcome.
RESULTS
RESULTS
We identified 10 randomized controlled trials with 1,015 participants. All of the studies compared an enteral formula or additional supplemental omega-3 fatty acids (eg, eicosapentaenoic acid, docosahexaenoic acid), γ-linolenic acid, and antioxidants. All of the studies reported mortality. For the primary outcome, there was no difference in all-cause mortality (for the longest period reported) with the use of an immunonutrition enteral formula or additional supplements of omega-3 fatty acids, γ-linolenic acid, and antioxidants (risk ratio = 0.79, 95% CI 0.59-1.07; low-quality evidence). For the secondary outcomes, we are uncertain whether immunonutrition with omega-3 fatty acids and antioxidants improves ICU length of stay, ventilator days, and oxygenation or increases harm.
CONCLUSIONS
CONCLUSIONS
This Cochrane meta-analysis of 10 studies of varying quality examined the effects of omega-3 fatty acids and antioxidants in adults with ARDS. This intervention may produce little or no difference in all-cause mortality between groups. We are uncertain whether immunonutrition with omega-3 fatty acids and antioxidants improves ventilator days, ICU length of stay, or oxygenation due to the very low quality of evidence.
Identifiants
pubmed: 31506339
pii: respcare.06965
doi: 10.4187/respcare.06965
doi:
Substances chimiques
Antioxidants
0
Fatty Acids, Omega-3
0
Docosahexaenoic Acids
25167-62-8
eicosapentaenoic acid ethyl ester
6GC8A4PAYH
gamma-Linolenic Acid
78YC2MAX4O
Eicosapentaenoic Acid
AAN7QOV9EA
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
99-110Informations de copyright
Copyright © 2020 by Daedalus Enterprises.
Déclaration de conflit d'intérêts
Dr Grocott has disclosed relationships with Baxter, BOC Medical (Linde Group), Eli Lilly Critical Care, Fresenius-Kabi, Smith Medical, Deltex Medical, London Clinic, and Rolex. Dr Calder has disclosed relationships with Abbott Nutrition, Baxter Healthcare, Danone/Nutricia, Fresenius-Kabi, Pronova BioPharma/BASF AS, and Smartfish. The other authors have disclosed no conflicts of interest. This article is based on a Cochrane Review published in the Cochrane Database of Systematic Reviews (CDSR) 2019, Issue 1, DOI: 10.1002/14651858.CD012041 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the CDSR should be consulted for the most recent version of the review.