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Naderi Y, Rad M, Sadatmoosavi A, Khaleghi E, Khorrami Z, Chamani G, Shabani M. Compared to oxcarbazepine and carbamazepine, botulinum toxin type A is a useful therapeutic option for trigeminal neuralgia symptoms: A systematic review. Clin Exp Dent Res 2024; 10:e882. [PMID: 38558383 PMCID: PMC10982606 DOI: 10.1002/cre2.882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES This review aimed to compare the effectiveness of three treatments: BTX A, CBZ, and OXB, in managing trigeminal neuralgia (TN). MATERIAL AND METHODS We conducted a thorough search for research articles related to our issue using specific keywords on several databases, including Cochrane Central Register of Controlled Trials, Science Direct, Scopus, PubMed, Elsevier, Springer Journals, Ovid Medline, EBSCO, and Web of Science. Our focus was on publications from 1965 to 2023. RESULTS We retrieved 46 articles from the search and reviewed them carefully. Out of these, we selected 29 articles that met the inclusion criteria. Among the selected articles, 11 investigated the effects of CBZ and OXB, while 18 explored the impact of BTX A on the improvement of TN symptoms. The response rate ranged between 56% and 90.5% for CBZ and between 90.9% and 94% for OXB. The response rate for BTX A ranged between 51.4% and 100%. All these three treatments had a remarkable effect on the improvement of TN. Importantly, findings highlighted that side effects of CBZ and OXB could lead to treatment discontinuation in some cases, whereas BTX A's side effects have been minimal and less frequent. CONCLUSIONS Consequently, BTX A emerges as a promising alternative for TN treatment. However, additional clinical trials are necessary to validate this finding, and further research is required to establish a standardized protocol for administering BTX A in TN.
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Affiliation(s)
- Yeganeh Naderi
- Oral and Dental Diseases Research CenterKerman University of Medical SciencesKermanIran
| | - Maryam Rad
- Oral and Dental Diseases Research CenterKerman University of Medical SciencesKermanIran
| | - Ali Sadatmoosavi
- Research Center for Modeling in HealthKerman University of Medical SciencesKermanIran
| | - Elham Khaleghi
- Research Center for Modeling in HealthKerman University of Medical SciencesKermanIran
| | - Zahra Khorrami
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision ScienceShahid Beheshti University of Medical ScienceTehranIran
| | - Goli Chamani
- Department of Dental Medicine, Karolinska InstituteScandinavian Center for Orofacial Neuroscience (SCON)HuddingeSweden
| | - Mohammad Shabani
- Neuroscience Research Center, Neuropharmacology InstituteKerman University of Medical SciencesKermanIran
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Zhou YY, Wang Y, Wang L, Jiang H. The efficacy of Omega-3 polyunsaturated fatty acids for severe burn patients: A systematic review and trial sequential meta-analysis of randomized controlled trials. Clin Nutr ESPEN 2024; 59:126-134. [PMID: 38220365 DOI: 10.1016/j.clnesp.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/03/2023] [Accepted: 11/26/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND & AIMS Severe burns lead to metabolic changes, systemic inflammatory response syndrome, and multiple organ dysfunction syndrome. Omege-3 polyunsaturated fatty acids (PUFAs) have anti-inflammatory properties. In the absence of substantial evidence for use on major burns, we systematically reviewed the efficacy of omega-3 PUFAs for patients with severe burns. METHODS We comprehensively searched MEDLINE, Web of Science, Embase, Cochrane Library, China National Knowledge Internet, Wang Fang Data, Chinese Biomedicine Database, and Science Direct databases to collect randomised controlled trials of omega-3 PUFAs administered to patients with burns from January 2000 to June 2023. Two researchers independently screened the literatures, extracted the data, and assessed the risk of bias in the included studies. The outcomes were mortality, the risk of severe sepsis, septic shock, and multiple organ dysfunction syndrome. Data synthesis was conducted using Review Manager. Trial sequential analyses (TSA) for outcomes were performed. RESULTS Three randomised controlled trials involving 140 patients were included. Of these, 71 patients received omega-3 PUFAs. The results showed that omega-3 PUFAs significantly reduced the incidence of severe sepsis, septic shock, multiple organ dysfunction syndrome (RR = 0.38, 95 % CI [0.19, 0.75], P = 0.005), C-reactive protein levels (MD = -39.70[-81.63, 2.23], P = 0.06), and improved respiratory outcomes. However, there was no difference in 14-day mortality (RR = 1.10, 95%CI [0.59, 2.05], P = 0.75). TSA showed that the results for the incidence of severe sepsis, septic shock, multiple organ dysfunction syndrome are insufficient and inconclusive. CONCLUSIONS Omega-3 PUFAs may reduce inflammatory response and risk of sepsis, septic shock, and multiple organ dysfunction syndrome in severe burns patients and may shorten hospital stay but cannot reduce risk of death. Due to the limitation of the quantity and quality of the included studies, the evidence level is low, and the conclusions need to be verified by larger scale and higher quality randomised controlled trials.
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Affiliation(s)
- Yi-Yue Zhou
- Department of Biology (life sciences), Sorbonne University, 4 Pl. Jussieu, Paris 75005, France.
| | - Yu Wang
- Department of Clinical Nutrition, Department of Health Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuai fu yuan Wang fu jing, Dong cheng District, Beijing 100730, China.
| | - Lu Wang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, Yi Huan Lu Xi Er Duan, Chengdu 610072, China; Sichuan Clinical Research Center for Emergency Medicine and Critical Illness, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, Yi Huan Lu Xi Er Duan, Chengdu 610072, China.
| | - Hua Jiang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, Yi Huan Lu Xi Er Duan, Chengdu 610072, China; Sichuan Clinical Research Center for Emergency Medicine and Critical Illness, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, Yi Huan Lu Xi Er Duan, Chengdu 610072, China.
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Yue HY, Zeng J, Wang Y, Deng MJ, Peng W, Tan X, Jiang H. Efficacy of omega-3 fatty acids for hospitalized COVID-19 patients: a systematic review and meta-analysis of randomized controlled trials. Asia Pac J Clin Nutr 2023; 32:308-320. [PMID: 37789651 PMCID: PMC11090385 DOI: 10.6133/apjcn.202309_32(3).0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/19/2023] [Accepted: 06/28/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Emerging expert consensuses and guidelines recommend that omega-3 fatty acids may have anti-inflammatory effects in hospitalized patients with coronavirus disease (COVID-19). However, these recommendations are based on pathophysiological studies of inflammation rather than direct clinical evidence. We conducted this systematic review and meta-analysis to evaluate the efficacy of omega-3 fatty acid supplementation in hospitalized patients with COVID-19. METHODS AND STUDY DESIGN We retrieved literature from PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), WANFANG, Chinese Biomedical Literature Database, and Cochrane Library databases up to May 1, 2023. Data from studies comparing omega-3 fatty acids with a placebo or other pharmaceutical nutrients were analyzed. RESULTS Of 3032 records, 42 full-text articles were reviewed, five eligible studies were identified, and one study was found in the references. In total of six studies involving 273 patients were included, pooled, and analyzed. Compared to the control group, omega-3 fatty acid intervention reduced the overall mortality of hospitalized patients with COVID-19 (RR=0.76; 95% CI, [0.61, 0.93]; p=0.010). No serious or unexpected drug-related adverse events were observed. No statistical significance was observed in inflammatory markers such as CRP (MD=-9.69; 95% CI, [-22.52, 3.15]; p=0.14; I2=97%) and IL-6; however, the neutrophil/lymphocyte ratio was significantly lower in the omega-3 FAs group on day 7 of intervention (p < 0.001). CONCLUSIONS Omega-3 fatty acid administration may be associated with reduced mortality in hospitalized patients with COVID-19. Given the small sample size of enrolled studies, more rigorous and large-scale trials are urgently needed in the future to verify its efficacy.
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Affiliation(s)
- Han-Yang Yue
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jun Zeng
- Sichuan Provincial Research Center for Emergency Medicine and Critical illness, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yu Wang
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Sichuan Provincial Research Center for Emergency Medicine and Critical illness, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Meng-Jie Deng
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Peng
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xin Tan
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, School of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hua Jiang
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Sichuan Provincial Research Center for Emergency Medicine and Critical illness, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
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Notz Q, Lee ZY, Menger J, Elke G, Hill A, Kranke P, Roeder D, Lotz C, Meybohm P, Heyland DK, Stoppe C. Omega-6 sparing effects of parenteral lipid emulsions-an updated systematic review and meta-analysis on clinical outcomes in critically ill patients. Crit Care 2022; 26:23. [PMID: 35045885 PMCID: PMC8767697 DOI: 10.1186/s13054-022-03896-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/11/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Parenteral lipid emulsions in critical care are traditionally based on soybean oil (SO) and rich in pro-inflammatory omega-6 fatty acids (FAs). Parenteral nutrition (PN) strategies with the aim of reducing omega-6 FAs may potentially decrease the morbidity and mortality in critically ill patients. METHODS A systematic search of MEDLINE, EMBASE, CINAHL and CENTRAL was conducted to identify all randomized controlled trials in critically ill patients published from inception to June 2021, which investigated clinical omega-6 sparing effects. Two independent reviewers extracted bias risk, treatment details, patient characteristics and clinical outcomes. Random effect meta-analysis was performed. RESULTS 1054 studies were identified in our electronic search, 136 trials were assessed for eligibility and 26 trials with 1733 critically ill patients were included. The median methodologic score was 9 out of 14 points (95% confidence interval [CI] 7, 10). Omega-6 FA sparing PN in comparison with traditional lipid emulsions did not decrease overall mortality (20 studies; risk ratio [RR] 0.91; 95% CI 0.76, 1.10; p = 0.34) but hospital length of stay was substantially reduced (6 studies; weighted mean difference [WMD] - 6.88; 95% CI - 11.27, - 2.49; p = 0.002). Among the different lipid emulsions, fish oil (FO) containing PN reduced the length of intensive care (8 studies; WMD - 3.53; 95% CI - 6.16, - 0.90; p = 0.009) and rate of infectious complications (4 studies; RR 0.65; 95% CI 0.44, 0.95; p = 0.03). When FO was administered as a stand-alone medication outside PN, potential mortality benefits were observed compared to standard care. CONCLUSION Overall, these findings highlight distinctive omega-6 sparing effects attributed to PN. Among the different lipid emulsions, FO in combination with PN or as a stand-alone treatment may have the greatest clinical impact. Trial registration PROSPERO international prospective database of systematic reviews (CRD42021259238).
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Affiliation(s)
- Quirin Notz
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Zheng-Yii Lee
- Department of Anesthesiology, University of Malaya, Kuala Lumpur, Malaysia
| | - Johannes Menger
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Gunnar Elke
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Aileen Hill
- Department of Anesthesiology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Peter Kranke
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Daniel Roeder
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Christopher Lotz
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Patrick Meybohm
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Daren K Heyland
- Department of Critical Care Medicine, Queen's University, Kingston, Canada
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Canada
| | - Christian Stoppe
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany.
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Witarto BS, Visuddho V, Witarto AP, Sutanto H, Wiratama BS, Wungu CDK. Efficacy, safety, and immunogenicity of rurioctocog alfa pegol for prophylactic treatment in previously treated patients with severe hemophilia A: a systematic review and meta-analysis of clinical trials. F1000Res 2021; 10:1049. [PMID: 35136579 PMCID: PMC8787562 DOI: 10.12688/f1000research.73884.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 04/06/2024] Open
Abstract
Background: Patients with severe hemophilia often present with painful joint and soft tissue bleeding which may restrict them from their daily activities. The current standard of care still relies on a regular prophylactic factor VIII (FVIII), which has a high daily treatment burden. Recently, rurioctocog alfa pegol, a third-generation recombinant FVIII with a modification in its polyethylene glycol (PEG) component, has been developed. Several trials have studied this synthetic drug as bleeding prophylaxis in severe hemophilia A. This study aims to evaluate the efficacy, safety, and immunogenicity of rurioctocog alfa pegol for previously treated patients with severe hemophilia A. Methods: This study was conducted in conformity with the PRISMA guidelines. Data were retrieved from PubMed, Scopus, Cochrane Library, Wiley Online Library, and CINAHL (via EBSCOhost). Study qualities were assessed using the Methodological Index for Non-Randomized Studies (MINORS) and Modified Jadad scales. Results: Four studies involving 517 previously treated severe hemophilia A patients were included in this study. The pooled mean of total annualized bleeding rate (ABR) and hemostatic efficacy was 2.59 (95% CI = 2.04-3.14) and 92% (95% CI = 85%-97%), respectively. Only 30 (2.3%) non-serious and one (1.4%) serious adverse events were considered related to rurioctocog alfa pegol treatment. At the end of the studies, no development of FVIII inhibitory antibodies was observed. None of the developed binding antibodies to FVIII, PEG-FVIII, or PEG was correlated to the treatment efficacy and safety. Conclusions: Despite the limited availability of direct comparison studies, our analyses indicate that rurioctocog alfa pegol could serve as a safe and effective alternative for bleeding prophylaxis in previously treated hemophilia A patients. Moreover, it appears to have low immunogenicity, which further increases the safety profile of the drug in such clinical conditions.
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Affiliation(s)
| | - Visuddho Visuddho
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Henry Sutanto
- Department of Physiology and Pharmacology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Bayu Satria Wiratama
- Department of Epidemiology, Biostatistics, and Population Health, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
| | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Universitas Airlangga, Surabaya, Indonesia
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
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Witarto BS, Visuddho V, Witarto AP, Sutanto H, Wiratama BS, Wungu CDK. Efficacy, safety, and immunogenicity of rurioctocog alfa pegol for prophylactic treatment in previously treated patients with severe hemophilia A: a systematic review and meta-analysis of clinical trials. F1000Res 2021; 10:1049. [PMID: 35136579 PMCID: PMC8787562 DOI: 10.12688/f1000research.73884.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Patients with severe hemophilia often present with painful joint and soft tissue bleeding which may restrict them from their daily activities. The current standard of care still relies on a regular prophylactic factor VIII (FVIII), which has a high daily treatment burden. Recently, rurioctocog alfa pegol, a third-generation recombinant FVIII with a modification in its polyethylene glycol (PEG) component, has been developed. Several trials have studied this synthetic drug as bleeding prophylaxis in severe hemophilia A. This study aims to evaluate the efficacy, safety, and immunogenicity of rurioctocog alfa pegol for previously treated patients with severe hemophilia A. Methods: This study was conducted in conformity with the PRISMA guidelines. Data were retrieved from PubMed, Scopus, Cochrane Library, Wiley Online Library, and CINAHL (via EBSCOhost). Study qualities were assessed using the Methodological Index for Non-Randomized Studies (MINORS) and Modified Jadad scales. Results: Four studies involving 517 previously treated severe hemophilia A patients were included in this study. The pooled mean of total annualized bleeding rate (ABR) and hemostatic efficacy was 2.59 (95% CI = 2.04-3.14) and 92% (95% CI = 85%-97%), respectively. Only 30 (2.3%) non-serious and one (1.4%) serious adverse events were considered related to rurioctocog alfa pegol treatment. At the end of the studies, no development of FVIII inhibitory antibodies was observed. None of the developed binding antibodies to FVIII, PEG-FVIII, or PEG was correlated to the treatment efficacy and safety. Conclusions: Despite the limited availability of direct comparison studies, our analyses indicate that rurioctocog alfa pegol could serve as a safe and effective alternative for bleeding prophylaxis in previously treated hemophilia A patients. Moreover, it appears to have low immunogenicity, which further increases the safety profile of the drug in such clinical conditions.
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Affiliation(s)
| | - Visuddho Visuddho
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Henry Sutanto
- Department of Physiology and Pharmacology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Bayu Satria Wiratama
- Department of Epidemiology, Biostatistics, and Population Health, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
| | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Universitas Airlangga, Surabaya, Indonesia
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
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7
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Witarto BS, Visuddho V, Witarto AP, Sutanto H, Wiratama BS, Wungu CDK. Efficacy safety and immunogenicity of rurioctocog alfa pegol for prophylactic treatment in previously treated patients with severe hemophilia A: a systematic review and meta-analysis of clinical trials. F1000Res 2021; 10:1049. [PMID: 35136579 PMCID: PMC8787562 DOI: 10.12688/f1000research.73884.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 04/06/2024] Open
Abstract
Background: Patients with severe hemophilia often present with painful joint and soft tissue bleeding which may restrict them from their daily activities. The current standard of care still relies on a regular prophylactic factor VIII (FVIII), which has a high daily treatment burden. Recently, rurioctocog alfa pegol, a third-generation recombinant FVIII with a modification in its polyethylene glycol (PEG) component, has been developed. Several trials have studied this synthetic drug as bleeding prophylaxis in severe hemophilia A. This study aims to evaluate the efficacy, safety, and immunogenicity of rurioctocog alfa pegol for previously treated patients with severe hemophilia A. Methods: This study was conducted in conformity with the PRISMA guidelines. Data were retrieved from PubMed, Scopus, Cochrane Library, Wiley Online Library, and CINAHL (via EBSCOhost). Study qualities were assessed using the Methodological Index for Non-Randomized Studies (MINORS) and Modified Jadad scales. Results: Four studies involving 517 previously treated severe hemophilia A patients were included in this study. The pooled mean of total annualized bleeding rate (ABR) and hemostatic efficacy was 2.59 (95% CI = 2.04-3.14) and 92% (95% CI = 85%-97%), respectively. Only 30 (2.3%) non-serious and one (1.4%) serious adverse events were considered related to rurioctocog alfa pegol treatment. At the end of the studies, no development of FVIII inhibitory antibodies was observed. None of the developed binding antibodies to FVIII, PEG-FVIII, or PEG was correlated to the treatment efficacy and safety. Conclusions: Despite the limited availability of direct comparison studies, our analyses indicate that rurioctocog alfa pegol could serve as a safe and effective alternative for bleeding prophylaxis in previously treated hemophilia A patients. Moreover, it appears to have low immunogenicity, which further increases the safety profile of the drug in such clinical conditions.
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Affiliation(s)
| | - Visuddho Visuddho
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Henry Sutanto
- Department of Physiology and Pharmacology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Bayu Satria Wiratama
- Department of Epidemiology, Biostatistics, and Population Health, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
| | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Universitas Airlangga, Surabaya, Indonesia
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
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Montejo González JC, de la Fuente O'Connor E, Martínez-Lozano Aranaga F, Servià Goixart L. Recommendations for specialized nutritional-metabolic treatment of the critical patient: Pharmaconutrients, specific nutrients, fiber, synbiotics. Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva 2021; 44 Suppl 1:39-43. [PMID: 32532409 DOI: 10.1016/j.medin.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/15/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023]
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9
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Xu Z, Meng Q, Ge X, Zhuang R, Liu J, Liang X, Fan H, Yu P, Zheng L, Zhou X. A short-term effect of caffeinated beverages on blood pressure: A meta-analysis of randomized controlled trails. J Funct Foods 2021. [DOI: 10.1016/j.jff.2021.104482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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10
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Jiang H, Zhang JC, Zeng J, Wang L, Wang Y, Lu CD, Deng L, Deng H, Wang K, Sun MW, Zhou P, Yuan T, Chen W. Gut, metabolism and nutritional Support for COVID-19: Experiences from China. BURNS & TRAUMA 2020; 8:tkaa048. [PMID: 33654695 PMCID: PMC7901705 DOI: 10.1093/burnst/tkaa048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/23/2020] [Indexed: 12/22/2022]
Abstract
There is little research that focuses on the relationship between the gut, metabolism, nutritional support and COVID-19. As a group of Chinese physicians, nutritionists and scientists working on the frontline treating COVID-19 patients, we aim to integrate our experiences and the current clinical evidence to address this pressing issue in this article. Based on our clinical observations and available evidence, we recommend the following practice. Firstly, the Nutritional Risk Screening 2002 tool should be used routinely and periodically; for patients with a score ≥3, oral nutritional supplements should be given immediately. Secondly, for patients receiving the antiviral agents lopinavir/ritonavir, gastrointestinal side effects should be monitored for and timely intervention provided. Thirdly, for feeding, the enteral route should be the first choice. In patients undergoing mechanical ventilation, establishing a jejunal route as early as possible can guarantee the feeding target being achieved if gastric dilatation occurs. Fourthly, we suggest a permissive underfeeding strategy for severe/critical patients admitted to the intensive care unit during the first week of admission, with the energy target no more than 20 kcal/kg/day (for those on mechanical ventilation, this target may be lowered to 10-15 kcal/kg/day) and the protein target around 1.0-1.2 g/kg/day. If the inflammatory condition is significantly alleviated, the energy target may be gradually increased to 25-30 kcal/kg/day and the protein target to 1.2-1.5 g/kg/day. Fifthly, supplemental parenteral nutrition should be used with caution. Lastly, omega-3 fatty acids may be used as immunoregulators, intravenous administration of omega-3 fatty emulsion (10 g/day) at an early stage may help to reduce the inflammatory reaction.
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Affiliation(s)
- Hua Jiang
- Institute for Emergency Medicine and Disaster Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China
- Emergency Intensive Care Unit, Emergency Medicine Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China
- Department of Acute Care Surgery, Emergency Medicine Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China
| | - Jian-Cheng Zhang
- Institute for Emergency Medicine and Disaster Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China
- Emergency Intensive Care Unit, Emergency Medicine Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China
| | - Jun Zeng
- Institute for Emergency Medicine and Disaster Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China
| | - Lu Wang
- Institute for Emergency Medicine and Disaster Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China
| | - Yu Wang
- Institute for Emergency Medicine and Disaster Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China
| | - Charles Damien Lu
- Institute for Emergency Medicine and Disaster Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China
| | - Lei Deng
- Emergency Intensive Care Unit, Emergency Medicine Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China
- Medical Task Force of Sichuan Provincial People’s Hospital to Union Red Cross Hospital of Wuhan, Wuhan, 430015, China
| | - Hongfei Deng
- Institute for Emergency Medicine and Disaster Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China
| | - Kai Wang
- Institute for Emergency Medicine and Disaster Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China
- Department of Acute Care Surgery, Emergency Medicine Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China
| | - Ming-Wei Sun
- Institute for Emergency Medicine and Disaster Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China
- Department of Acute Care Surgery, Emergency Medicine Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China
| | - Ping Zhou
- Institute for Emergency Medicine and Disaster Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China
- Emergency Intensive Care Unit, Emergency Medicine Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China
| | - Ting Yuan
- Institute for Emergency Medicine and Disaster Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China
| | - Wei Chen
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuai fu yuan Wang fu jing Dong cheng District, Beijing, 100730, China
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11
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Uhlig C, Rössel T, Denz A, Seifert S, Koch T, Heller AR. Effects of a metabolic optimized fast track concept (MOFA) on bowel function and recovery after surgery in patients undergoing elective colon or liver resection: a randomized controlled trial. BMC Anesthesiol 2019; 19:156. [PMID: 31421670 PMCID: PMC6698338 DOI: 10.1186/s12871-019-0823-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/06/2019] [Indexed: 12/26/2022] Open
Abstract
Background Enhanced recovery after surgery programs (ERAS) using thoracic epidural anesthesia and perioperative patient conditioning with omega-3 fatty acids (n3FA), glucose control (GC) and on-demand fluid therapy, respectively, showed beneficial effects. In the MOFA- study these components were used together in patients undergoing colon or liver surgery. We hypothesized that the use of a perioperative MOFA program improves intestine function represented as time to the first postoperative bowel movement in adult patients compared to standard ERAS. Methods After BfArM and IRB approval 100 patients were enrolled in this prospective randomized controlled trial. All patients received ERAS therapy (control). In addition, the MOFA group received 0.2 g/kg fish oil (Omegaven®), preoperatively, followed by a 48 h continuous infusion of 0.2 g/kg/d n3FA; and GC was kept below < 8 mmol/L. Pre- and postoperatively energy drinks were administered. Results As compared to control group the MOFA concept resulted in an earlier onset of flatulence by 14 h (46.6 ± 25.7, 32.0 ± 17.9, p = 0.030, hours, control vs. MOFA, respectively). Effects on onset of bowel movement were not observed (74.5 ± 30.4, 66.4 ± 29.2, p = 0.163, hours, control vs. MOFA, respectively). The disease severity (SAPS II score; p = 0.720) as well as deployment of resources (TISS 28 score, p = 0.709) did not differ between groups. No statistic significant difference between MOFA and control group regarding inflammation, impairment of coagulation, length of hospital stay or incidence of postoperative surgical complications were observed. Conclusions The MOFA concept did not result in an improvement of intestine function or faster recovery after elective colon or liver surgery compared to standard ERAS therapy. Omega-3 fatty acids showed no impairment of coagulation or improved resolution of inflammation. Further trials in a larger patient collective are needed to investigate potential beneficial effects of omega-3 fatty acids in abdominal surgery. Trial registration This trial was prospectively registered at the European Union Clinical Trials Register (EuDraCT 2005–004814-33, date: 10-05-2005, https://www.clinicaltrialsregister.eu/ctr-search/search?query=2005-004814-33+). Electronic supplementary material The online version of this article (10.1186/s12871-019-0823-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christopher Uhlig
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Thomas Rössel
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Axel Denz
- Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany.,Department of General Surgery, University Hospital of Friedrich-Alexander-University, Erlangen, Germany
| | - Sven Seifert
- Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany.,Department of Thorax, Vascular and Endovascular Surgery, Chemnitz Hospital, Chemnitz, Germany
| | - Thea Koch
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Axel Rüdiger Heller
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.,Department of Anaesthesiology and Surgical Intensive Care Medicine, University Hospital Augsburg, Augsburg, Germany
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12
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Moran JL, Graham PL. Risk related therapy in meta-analyses of critical care interventions: Bayesian meta-regression analysis. J Crit Care 2019; 53:114-119. [PMID: 31228761 DOI: 10.1016/j.jcrc.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 06/03/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE The relationship between treatment efficacy and patient risk is explored in a series of meta-analyses from the critical care domain, focusing on mortality outcome. METHODS Systematic reviews of randomized controlled trials were identified by electronic search over the period 2002 to July 2018. A Bayesian meta-regression model was employed, using the risk difference metric to estimate the relationship between mortality difference and control arm risk, and estimate the mortality difference with and without adjusting for control arm risk. RESULTS Of 780 initially identified published systematic reviews, 113 had appropriate mortality data comprising 123 analysable groups. The 123 meta-analyses were pharmaceutical therapeutic (59.3%), non-pharmaceutical therapeutic (24.4%) and nutritional (16.3%), with a 25% overall average control arm mortality. In 25/123 (20%) analyses, meta-regression indicated significant baseline risk (Bayesian 95% credible intervals excluding zero). In all analyses, the relationship between risk-difference and control arm risk was negative indicating a positive treatment effect with increasing control arm risk. Adjusted estimates identified six studies with significant positive treatment effects, not evident until after adjustment for control arm risk. CONCLUSION Underlying risk-related therapy is apparent in meta-analyses of the critically-ill and identification is of importance to both the conduct and interpretation of these meta-analyses.
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Affiliation(s)
- John L Moran
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia.
| | - Petra L Graham
- Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie Business School, Macquarie University, North Ryde, NSW 2109, Australia.
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13
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Abstract
PURPOSE OF REVIEW Lipid emulsions are an integral part of parenteral nutrition. Enteral nutrition is the preferred route to feed critically ill patients and parenteral nutrition is used in case of contraindications or when enteral nutrition does not reach the nutritional goals. n-3 Lipids are included into some newer lipid emulsions including fish oil or may be added by a fish oil-based lipid emulsion to lipid emulsion without fish oil. This review focuses on recent clinical trials, metaanalyses, and guidelines of parenteral nutrition with n-3 lipids in critically ill patients. RECENT FINDINGS Two single-center studies report a mortality benefit of adding fish oil-based lipid emulsions to the parenteral nutrition. Metaanalyses performed without these two studies had demonstrated beneficial effects of n-3 lipids regarding infections, length of stay, and time of mechanical ventilation but not on mortality. However, all metaanalyses judged the database derived from the underlying studies as not sufficient for a firm recommendation. Consecutively, guidelines and expert groups issue very cautious recommendations for the use of n-3 lipids in parenteral nutrition. SUMMARY Beneficial effects of n-3 lipids in trials and metaanalyses became available; however, high-quality multicenter randomized controlled trials are needed before more endorsing recommendation will be available.
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Affiliation(s)
- Konstantin Mayer
- University of Giessen and Marburg Lung Center (UGMLC), University Hospital of Giessen and Marburg, Justus Liebig University, Giessen, Germany
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14
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Current Evidence for the Use of Smoflipid® Emulsion in Critical Care Patients for Parenteral Nutrition. Crit Care Res Pract 2018; 2018:6301293. [PMID: 30584476 PMCID: PMC6280253 DOI: 10.1155/2018/6301293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/12/2018] [Indexed: 12/14/2022] Open
Abstract
There are strong data showing that malnutrition is highly prevalent in intensive care unit patients (20–50% in the worldwide), presenting a negative accumulated body energy balance. This results in an increased mortality, infections, and hospital length stay with high costs associated with the total treatment. Parenteral nutrition is the first option when the patient's physical condition is not suitable for oral nutrient intake. It is composed essentially by lipids as an energy source, metabolic, and structural function. However, these patients also require a mixture of essential and nonessential fatty acids (SMOF emulsions) to supply not only energy needs but also restore immunological, anti-inflammatory, and proregenerative functions. A revision of the safety and efficacy of Smoflipid® in patients requiring long-term parenteral nutrition was discussed here. Although controversial data are available indicating the contraindications or effectiveness of its use, most of studies presented indicate favorable benefits associated with improved clinical outcomes. The reported roles of this supplementation include positive immunomodulatory and anti-inflammatory effects, positive impact in liver function, reduction of hospital stay, and nosocomial infections as additional contributions to its energetic role, which in many cases results in reduced total costs per patient. Finally, many authors propose that the use of Smoflipid® should become a gold standard of parenteral nutrition in intensive unit care patients and that the costs associated with this supplement should not be limiting for its use, not only to improve the clinical outcome but also to reduce the treatment costs.
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15
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ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 2018; 38:48-79. [PMID: 30348463 DOI: 10.1016/j.clnu.2018.08.037] [Citation(s) in RCA: 1311] [Impact Index Per Article: 218.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 02/07/2023]
Abstract
Following the new ESPEN Standard Operating Procedures, the previous guidelines to provide best medical nutritional therapy to critically ill patients have been updated. These guidelines define who are the patients at risk, how to assess nutritional status of an ICU patient, how to define the amount of energy to provide, the route to choose and how to adapt according to various clinical conditions. When to start and how to progress in the administration of adequate provision of nutrients is also described. The best determination of amount and nature of carbohydrates, fat and protein are suggested. Special attention is given to glutamine and omega-3 fatty acids. Particular conditions frequently observed in intensive care such as patients with dysphagia, frail patients, multiple trauma patients, abdominal surgery, sepsis, and obesity are discussed to guide the practitioner toward the best evidence based therapy. Monitoring of this nutritional therapy is discussed in a separate document.
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16
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Abbasoglu O, Hardy G, Manzanares W, Pontes-Arruda A. Fish Oil-Containing Lipid Emulsions in Adult Parenteral Nutrition: A Review of the Evidence. JPEN J Parenter Enteral Nutr 2017; 43:458-470. [PMID: 28792885 DOI: 10.1177/0148607117721907] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/30/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is evidence from laboratory and animal studies that fish oil-containing intravenous lipid emulsions (FOC-IVLEs) have a beneficial effect on inflammation and the immune response, suggesting a possible clinical benefit. Clinical studies of FOC-IVLEs have reported mixed results. The aim of this review is to present findings from recent randomized controlled clinical trials and other quality clinical studies investigating the effects of administering intravenous fish oil alone or as part of a multilipid emulsion and to examine the quality of these studies in an objective, evidence-based manner. METHODS Studies comparing FOC-IVLEs with other IVLEs in adults were included. Thirty-four clinical studies were evaluated: 19 investigated levels of inflammatory and immune markers as an endpoint; 13 investigated rates of infection or sepsis; 3 investigated clinical outcomes in septic patients; and 29 investigated general clinical outcomes. RESULTS There was conflicting evidence for a beneficial effect of fish oil on levels of inflammatory and immune markers and some evidence that fish oil decreased the rate of postoperative atrial fibrillation. Studies generally reported few statistical differences in clinical outcomes and rates of infection and sepsis with FOC-IVLEs as compared with other IVLEs. The quality of reporting was generally poor, and the presented evidence for comparisons between FOC-IVLEs and other IVLEs was inconclusive or weak. CONCLUSIONS There is very little high-quality evidence that FOC-IVLEs have a more beneficial effect than other IVLEs on clinical outcomes in adult patients.
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Affiliation(s)
- Osman Abbasoglu
- Division of Nutrition Support, Department of General Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gil Hardy
- College of Health, Massey University, Auckland, New Zealand
| | - William Manzanares
- Intensive Care Unit, Department of Critical Care, Faculty of Medicine, Universidad de la República, Montevideo, Uruguay
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17
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Calder PC, Adolph M, Deutz NE, Grau T, Innes JK, Klek S, Lev S, Mayer K, Michael-Titus AT, Pradelli L, Puder M, Vlaardingerbroek H, Singer P. Lipids in the intensive care unit: Recommendations from the ESPEN Expert Group. Clin Nutr 2017; 37:1-18. [PMID: 28935438 DOI: 10.1016/j.clnu.2017.08.032] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 12/11/2022]
Abstract
This article summarizes the presentations given at an ESPEN Workshop on "Lipids in the ICU" held in Tel Aviv, Israel in November 2014 and subsequent discussions and updates. Lipids are an important component of enteral and parenteral nutrition support and provide essential fatty acids, a concentrated source of calories and building blocks for cell membranes. Whilst linoleic acid-rich vegetable oil-based enteral and parenteral nutrition is still widely used, newer lipid components such as medium-chain triglycerides and olive oil are safe and well tolerated. Fish oil (FO)-enriched enteral and parenteral nutrition appears to be well tolerated and confers additional clinical benefits, particularly in surgical patients, due to its anti-inflammatory and immune-modulating effects. Whilst the evidence base is not conclusive, there appears to be a potential for FO-enriched nutrition, particularly administered peri-operatively, to reduce the rate of complications and intensive care unit (ICU) and hospital stay in surgical ICU patients. The evidence for FO-enriched nutrition in non-surgical ICU patients is less clear regarding its clinical benefits and additional, well-designed large-scale clinical trials need to be conducted in this area. The ESPEN Expert Group supports the use of olive oil and FO in nutrition support in surgical and non-surgical ICU patients but considers that further research is required to provide a more robust evidence base.
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Affiliation(s)
- Philip C Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton SO16 6YD, United Kingdom.
| | - Michael Adolph
- Department of Anesthesiology and Intensive Care Medicine, Nutrition Support Team, University Clinic Tübingen, 72074 Tübingen, Germany
| | - Nicolaas E Deutz
- Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA
| | - Teodoro Grau
- Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Jacqueline K Innes
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Stanislaw Klek
- General and Oncology Surgery Unit, Intestinal Failure Center, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Shaul Lev
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Hasharon Hospital and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Konstantin Mayer
- Department of Internal Medicine, Med. Clinik II, University Hospital Giessen and Marburg, 35392 Giessen, Germany
| | - Adina T Michael-Titus
- Centre for Neuroscience and Trauma, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom
| | - Lorenzo Pradelli
- AdRes Health Economics and Outcomes Research, 10121 Turin, Italy
| | - Mark Puder
- Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA
| | - Hester Vlaardingerbroek
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Hasharon Hospital and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Chanda W, Joseph TP, Padhiar AA, Guo X, Min L, Wang W, Lolokote S, Ning A, Cao J, Huang M, Zhong M. Combined effect of linolenic acid and tobramycin on Pseudomonas aeruginosa biofilm formation and quorum sensing. Exp Ther Med 2017; 14:4328-4338. [PMID: 29104645 PMCID: PMC5658730 DOI: 10.3892/etm.2017.5110] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/22/2017] [Indexed: 12/28/2022] Open
Abstract
Pseudomonas aeruginosa is a ubiquitous Gram negative opportunistic pathogen capable of causing severe nosocomial infections in humans, and tobramycin is currently used to treat P. aeruginosa associated lung infections. Quorum sensing regulates biofilm formation which allows the bacterium to result in fatal infections forcing clinicians to extensively use antibiotics to manage its infections leading to emerging multiple drug resistant strains. As a result, tobramycin is also becoming resistant. Despite extensive studies on drug discovery to alleviate microbial drug resistance, the continued microbial evolution has forced researchers to focus on screening various phytochemicals and dietary compounds for antimicrobial potential. Linolenic acid (LNA) is an essential fatty acid that possesses antimicrobial actions on various microorganisms. It was hypothesized that LNA may affect the formation of biofilm on P. aeruginosa and improve the potency of tobramycin. The present study demonstrated that LNA interfered with cell-to-cell communication and reduced virulence factor production. It further enhanced the potency of tobramycin and synergistically inhibited biofilm formation through P. aeruginosa quorum sensing systems. Therefore, LNA may be considered as a potential agent for adjunctive therapy and its utilization may decrease tobramycin concentration in combined treatment thereby reducing aminoglycoside adverse effects.
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Affiliation(s)
- Warren Chanda
- Department of Microbiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, Liaoning 116044 P.R. China
| | - Thomson Patrick Joseph
- Department of Microbiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, Liaoning 116044 P.R. China
| | - Arshad Ahmed Padhiar
- Department of Microbiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, Liaoning 116044 P.R. China
| | - Xuefang Guo
- Department of Microbiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, Liaoning 116044 P.R. China
| | - Liu Min
- Department of Microbiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, Liaoning 116044 P.R. China
| | - Wendong Wang
- Department of Microbiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, Liaoning 116044 P.R. China
| | - Sainyugu Lolokote
- Department of Epidemiology and Biostatistics, School of Public Health, Dalian Medical University, Dalian, Liaoning 116044 P.R. China
| | - Anhong Ning
- Laboratory of Pathogen Biology, Experimental Teaching Center for Basic Medical Sciences, Dalian Medical University, Dalian, Liaoning 116044 P.R. China
| | - Jing Cao
- Laboratory of Pathogen Biology, Experimental Teaching Center for Basic Medical Sciences, Dalian Medical University, Dalian, Liaoning 116044 P.R. China
| | - Min Huang
- Department of Microbiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, Liaoning 116044 P.R. China
| | - Mintao Zhong
- Department of Microbiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, Liaoning 116044 P.R. China
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Lu C, Sharma S, McIntyre L, Rhodes A, Evans L, Almenawer S, Leduc L, Angus DC, Alhazzani W. Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials. Ann Intensive Care 2017; 7:58. [PMID: 28585162 PMCID: PMC5459780 DOI: 10.1186/s13613-017-0282-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/23/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Nutritional supplementation of omega-3 fatty acids has been proposed to modulate the balance of pro- and anti-inflammatory mediators in sepsis. If proved to improve clinical outcomes in critically ill patients with sepsis, this intervention would be easy to implement. However, the cumulative evidence from several randomized clinical trials (RCTs) remains unclear. METHODS We searched the Cochrane Library, MEDLINE, and EMBASE through December 2016 for RCTs on parenteral or enteral omega-3 supplementation in adult critically ill patients diagnosed with sepsis or septic shock. We analysed the included studies for mortality, intensive care unit (ICU) length of stay, and duration of mechanical ventilation, and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the quality of the evidence for each outcome. RESULTS A total of 17 RCTs enrolling 1239 patients met our inclusion criteria. Omega-3 supplementation compared to no supplementation or placebo had no significant effect on mortality [relative risk (RR) 0.85; 95% confidence interval (CI) 0.71, 1.03; P = 0.10; I 2 = 0%; moderate quality], but significantly reduced ICU length of stay [mean difference (MD) -3.79 days; 95% CI -5.49, -2.09; P < 0.0001, I 2 = 82%; very low quality] and duration of mechanical ventilation (MD -2.27 days; 95% CI -4.27, -0.27; P = 0.03, I 2 = 60%; very low quality). However, sensitivity analyses challenged the robustness of these results. CONCLUSION Omega-3 nutritional supplementation may reduce ICU length of stay and duration of mechanical ventilation without significantly affecting mortality, but the very low quality of overall evidence is insufficient to justify the routine use of omega-3 fatty acids in the management of sepsis.
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Affiliation(s)
- Clara Lu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Sunjay Sharma
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Canada
| | - Lauralyn McIntyre
- Department of Medicine (Critical Care), The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Andrew Rhodes
- Department of Intensive Care Medicine, St George's Hospital, Blackshaw Road, London, UK
| | - Laura Evans
- Department of Medicine, Division of Pulmonary Medicine and Critical Care, New York University, New York City, NY, USA
| | - Saleh Almenawer
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Canada
| | - Lori Leduc
- St. Joseph's Healthcare Hamilton, 50 Charlton Avenue, L8N 4A6, Hamilton, ON, Canada
| | - Derek C Angus
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Waleed Alhazzani
- St. Joseph's Healthcare Hamilton, 50 Charlton Avenue, L8N 4A6, Hamilton, ON, Canada. .,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada. .,Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada.
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20
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Kota H, Chamberlain RS. Immunonutrition Is Associated With a Decreased Incidence of Graft-Versus-Host Disease in Bone Marrow Transplant Recipients: A Meta-Analysis. JPEN J Parenter Enteral Nutr 2016; 41:1286-1292. [DOI: 10.1177/0148607116663278] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Harshitha Kota
- Saint George’s University School of Medicine, Grenada, West Indies
| | - Ronald S. Chamberlain
- Saint George’s University School of Medicine, Grenada, West Indies
- New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
- Department of Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
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21
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Kagan I, Theilla M, Singer P. Is Total Parenteral Nutrition (TPN) an Evil in Trauma Patients? CURRENT TRAUMA REPORTS 2016. [DOI: 10.1007/s40719-016-0041-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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22
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Enteral Immunomodulatory Diet (Omega-3 Fatty Acid, γ-Linolenic Acid and Antioxidant Supplementation) for Acute Lung Injury and Acute Respiratory Distress Syndrome: An Updated Systematic Review and Meta-Analysis. Nutrients 2015; 7:5572-85. [PMID: 26184293 PMCID: PMC4517016 DOI: 10.3390/nu7075239] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 06/17/2015] [Accepted: 06/23/2015] [Indexed: 01/11/2023] Open
Abstract
Enteral immunomodulatory nutrition is considered as a promising therapy for the treatment of acute lung injury and acute respiratory distress syndrome (ALI/ARDS). However, there are still some divergences, and it is unclear whether this treatment should be recommended for patients with ALI/ARDS. Therefore, we conducted this systematic review and meta-analysis to assess the efficacy and safety of an enteral immunomodulatory diet on the clinical outcomes of ALI/ARDS patients. Methods: We retrieved potentially relevant clinical trials though electronic databases. All trials of enteral immunomodulatory diet for ALI/ARDS were included. Analyses of the overall all-cause mortality, 28-day ventilator-free days and 28-day intensive care unit (ICU) free days were conducted. Results: In total six controlled trials were evaluated. The pooled results did not show a significant reduction in the risk of all-cause mortality (M-H RR (the overall Mantel-Haenszel relative risk), 0.81 (95% CI, 0.50–1.31); p = 0.38; 6 trials, n = 717) in ALI/ARDS patients treated with the immunomodulatory diet. This treatment also did not extend the ventilator-free days and ICU-free days. However, patients with high mortality might benefit from this treatment. Conclusions: The enteral immunomodulatory diet could not reduce the severity of the patients with ALI/ARDS. Whereas, for ALI/ARDS patients with high mortality, this treatment might reduce the all-cause mortality, but its use should be treated with discretion.
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23
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Intravenous fish oil lipid emulsions in critically ill patients: an updated systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:167. [PMID: 25879776 PMCID: PMC4404291 DOI: 10.1186/s13054-015-0888-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/17/2015] [Indexed: 12/14/2022]
Abstract
INTRODUCTION 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). CONCLUSION 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.
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Fremont RD, Rice TW. Pros and cons of feeding the septic intensive care unit patient. Nutr Clin Pract 2015; 30:344-50. [PMID: 25855092 DOI: 10.1177/0884533615578457] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Sepsis is a common disease seen in critically ill patients. Many patients with sepsis are unable to provide nutrition for themselves, and therefore initiating artificial nutrition has become part of routine care for these patients. However, studies investigating the optimal route, composition, volume, and duration of nutrition in critically ill patients with sepsis are lacking. The best recommendations have to be extrapolated from studies in heterogeneous populations of critically ill patients or in those with syndromes such as acute lung injury or acute respiratory distress syndrome (ARDS) where sepsis is a common predisposing etiology. In this review, we summarize pertinent studies that inform clinical practice on providing artificial nutrition to critically ill patients with severe sepsis and make recommendations as to how these studies influence clinical care of these patients.
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Affiliation(s)
- Richard D Fremont
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Meharry Medical College, Nashville, Tennessee
| | - Todd W Rice
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
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