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To investigate the effect of a fish oil containing parenteral lipid emulsion on inflammatory markers, gas exchange and clinical outcomes in septic patients

dc.contributor.advisorBlaauw, Reneeen_ZA
dc.contributor.advisorSpruyt, Marykeen_ZA
dc.contributor.authorDonoghue, Veroniqueen_ZA
dc.contributor.otherStellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.en_ZA
dc.date.accessioned2018-02-23T12:56:33Z
dc.date.accessioned2018-04-09T11:46:31Z
dc.date.available2019-02-28T03:00:14Z
dc.date.issued2018-03
dc.identifier.urihttp://hdl.handle.net/10019.1/103876
dc.descriptionThesis (MNutr)--Stellenbosch University, 2018.en_ZA
dc.description.abstractENGLISH SUMMARY : Introduction: The effects of intravenous lipid emulsions containing fish oil in critically ill patients have not been studied widely and show conflicting results. This study compared the effects of a 4-oil lipid emulsion (SMOFlipid®) with a 100% soybean-based lipid emulsion in terms of biochemical parameters, inflammatory mediators, plasma total phospholipid fatty acid (FA) composition, sequential organ failure assessment (SOFA) score, gas exchange and clinical outcomes in patients with the systemic inflammatory response syndrome (SIRS) with or without sepsis. Design: Double blind, randomised, single-centre study. Method: Seventy-five patients predicted to need parenteral nutrition (PN) for ≥ five days were randomised to receive either a 4-oil lipid emulsion (Study Group (SG)) or a 100% soybean lipid emulsion (Control Group (CG)). Isocaloric, isonitrogenous PN was administered continuously. Routine biochemical measurements and gas exchange were assessed. SOFA score was calculated and plasma cytokines and total phospholipid FA composition was analysed. Results: Both groups were well matched for baseline characteristics, but the SG had a trend to a higher mean APACHE II score (13.7 ± 7.5 versus 11.2 ± 8.1, p=0.19). The nutritional intakes did not differ, except the SG received fish oil (FO), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and increased amounts of α-tocopherol and reduced amounts of phytosterols. Triglycerides and Gamma-glutamyl transferase (GGT) levels increased in both groups. Bilirubin levels decreased in both groups between day 1 and 3 and then continued to decrease in the SG, but increased significantly in the CG after day 3. Concentrations of TNF-α decreased from day 1 to day 6 in the SG, whereas they increased in the CG, but the difference was not significant. Concentrations of interleukin-1β (IL-1β) and IL-6 decreased in the SG during the intervention and increased in the CG after day 3; however the difference was not significant at day 6. IL-10 concentrations decreased in both groups between day 1 and day 3, but increased from day 3 to day 6 in the SG. This difference was not significant (p=0.972). Multiple positive changes in plasma total phospholipid FA percentages were demonstrated. Plasma EPA showed a significant increase in the SG (p<0.001). The n-6 polyunsaturated fatty acid (PUFA):n-3 PUFA ratio decreased in the SG and remained fairly constant in the CG. A significant correlation was found for day 3 EPA intake and improvement in SOFA score. Days on mechanical ventilation and ICU LOS were not different between the two groups. Conclusion: The results of this study suggest that PN containing a 4-oil LE with FO at a dose of 0.09 – 0.22g/kg in patients with SIRS, with or without sepsis, was associated with multiple changes in the plasma total phospholipid FA composition and a tendency to reduce plasma TNF-α and liver enzymes. There was no significant difference in terms of SOFA score, length of ICU stay and mortality. Additional studies need to be done in this patient population paying particular attention to the dose, duration and timing of FO and EPA per day and their effect on clinical outcomes.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING : Inleiding: Die uitwerking van intraveneuse lipiedemulsies (LE) wat visolie bevat is nie uitgebreid by krities siek pasiënte bestudeer nie en toon teenstrydige resultate. Hierdie studie het die uitwerking van 'n 4-olie lipiedemulsie (SMOFlipid®) met 'n 100 % sojaboon-gebaseerde lipiedemulsie vergelyk m.b.t. biochemiese parameters, inflammatoriese mediators, samestelling van totale fosfolipied- vetsuur (VS) in plasma, evaluering van opeenvolgende orgaanversaking (OOV)-telling, gaswisseling en kliniese uitkomste by pasiënte met sistemiese inflammatoriese responssindroom (SIRS), met of sonder sepsis. Ontwerp: Dubbelblinde, ewekansige, enkel sentrum studie Metode: Vyf-en-sewentig pasiënte by wie daar die behoefte voorspel was vir parenterale voeding (PV) van vyf dae, is ewekansig toegewys om óf 'n 4-olie lipiedemulsie (studiegroep (SG)), of 'n 100 % sojaboon-lipiedemulsie (kontrolegroep (KG) te ontvang. Isokaloriese, isonitrogene PV is deurlopend toegedien. Roetine biochemiese metings en gaswisseling is ondersoek. OOV -telling is bereken en plasma sitokiene en totale fosfolipied VS samestelling is ontleed. Resultate: Beide groepe het goed ooreengekom betreffende hul basislyn eienskappe, maar die SG het 'n neiging gehad tot 'n hoër gemiddelde APACHE II - telling (13.7 ± 7.5 teenoor 11.2 ± 8.1, p = 0.19). Die voedingsinnames het nie verskil nie, behalwe dat die SG visolie (VO), eikosapentaenoësuur (EPA) en dokosaheksaenoësuur (DHA), meer α-tokoferol en minder fitosterole ontvang het. Trigliseriede en gamma-glutamieltransferase (GGT) vlakke het by beide groepe toegeneem. Bilirubienvlakke het by albei groepe tussen Dag 1 en 3 verlaag en toe aangehou om te daal by die SG, maar het beduidend gestyg by die KG na Dag 3. Konsentrasies van TNF-α het van Dag 1 tot Dag 6 in die SG gedaal, terwyl dit in die KG toegeneem het, maar die verskil was nie beduidend nie. Konsentrasies van interleukien-1β (IL-1β) en IL-6 het met die ingryping by die SG gedaal en na Dag 3 by die KG toegeneem, maar die verskil was nie beduidend op Dag 6 nie. IL-10 konsentrasies het by beide groepe tussen Dag 1 en Dag 3 afgeneem, maar toegeneem vanaf Dag 3 tot Dag 6 in die SG. Hierdie verskil was nie beduidend nie (p=0.972). Veelvuldige positiewe veranderinge in die plasma se totale fosfolipied VS persentasies is aangetoon. Plasma EPA het 'n beduidende toename in die SG getoon (P<0.001). Die n-6 poli-onversadigde VS (POVS): n-3 POVS -verhouding het by die SG afgeneem en het redelik konstant by die KG gebly. 'n Beduidende korrelasie was aangetoon vir Dag 3 EPA inname en verbetering in OOV-telling. Dae op meganiese ventilasie en intensiewesorg eenheid (ISE) LVV het nie verskil tussen die twee groepe nie. Gevolgtrekking: Die resultate van hierdie studie dui daarop dat PV wat 'n 4-olie LE met VO teen 'n dosis van 0,09 - 0,22 g/kg by pasiënte met SIRS met of sonder sepsis bevat, verband hou met veelvuldige veranderinge in plasma totale fosfolipied vetsuur samestelling en ʼn neiging tot ʼn verlaging in plasma TNF-α and lewerensieme. Daar was geen beduidende verskil in terme van die OOV –telling, lengte van ISE verblyf asook mortaliteit nie. Bykomende studies moet by hierdie pasiëntpopulasie gedoen word, met spesiale aandag aan die dosis, duur en tydsberekening van VO en EPA per dag en die uitwerking daarvan op kliniese uitkomste.af_ZA
dc.format.extentxxiii, 234 pages ; illustrations, includes annexures
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch University
dc.subjectFat emulsions, Intravenous -- Side effectsen_ZA
dc.subjectFish oils in human nutrition -- Health aspectsen_ZA
dc.subjectSepticemia -- Patients -- Nutritionen_ZA
dc.subjectBiochemical markersen_ZA
dc.subjectUCTD
dc.titleTo investigate the effect of a fish oil containing parenteral lipid emulsion on inflammatory markers, gas exchange and clinical outcomes in septic patientsen_ZA
dc.typeThesisen_ZA
dc.rights.holderStellenbosch University
dc.embargo.terms2019-02-28


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