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Lipid Use in Hospitalized Adults Requiring Parenteral Nutrition
Author(s) -
Mayer Konstantin,
Klek Stanislaw,
GarcíadeLorenzo Abelardo,
Rosenthal Martin D.,
Li Ang,
Evans David C.,
Muscaritoli Maurizio,
Martindale Robert G.
Publication year - 2020
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1733
Subject(s) - parenteral nutrition , fish oil , eicosapentaenoic acid , docosahexaenoic acid , medicine , acute pancreatitis , sepsis , soybean oil , polyunsaturated fatty acid , intensive care unit , lipid emulsion , pancreatitis , intensive care medicine , fatty acid , gastroenterology , chemistry , biochemistry , fish <actinopterygii> , biology , pathology , fishery
In hospitalized patients, lipid emulsions are an integral part of balanced parenteral nutrition. Traditionally, a single lipid source, soybean oil, has been given to patients and was usually regarded as just a source of energy and to prevent essential fatty‐acid deficiency. However, mixtures of different lipid emulsions have now become widely available, including mixtures of soybean oil, medium‐chain triglycerides, olive oil, and fish oil. Fish oil is high in the ω‐3 polyunsaturated fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). There is a growing body of evidence that these ω‐3 fatty acids can exert beneficial immunomodulatory, anti‐inflammatory, and inflammation‐resolution effects across a wide range of patient groups including surgical, cancer, and critically ill patients. At least in part, these effects are realized via potent specialized pro‐resolution mediators (SPMs). Moreover, parenteral nutrition including ω‐3 fatty acids can result in additional clinical benefits over the use of standard lipid emulsions, such as reductions in infection rates and length of hospital and intensive care unit stay. Clinical and experimental evidence is reviewed regarding lipid emulsion use in a variety of hospitalized patient groups, including surgical, critically ill, sepsis, trauma, and acute pancreatitis patients. Practical aspects of lipid emulsion use in critically ill patients are also considered, such as how to determine and fulfill energy expenditure, how and when to consider parenteral nutrition, duration of infusion, and safety monitoring.