Effect of enteral feeding with eicosapentaenoic acid, γ-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome

James E. Gadek, Stephen J. DeMichele, Michael Karlstad, Eric R. Pacht, Michael Donahoe, Timothy E. Albertson, Chi Van Hoozen, Ann K. Wennberg, Jeffrey L. Nelson, Mojtaba Noursalehi, Jan Drake, Pat Farmer, Judy Hart, Carol Koetting-Freeman, Nancy Rague, Ed Cruz, Cathy Mucenski, Steve Morris, Kathy Gardener, Mary Moore & 18 others Jay Whelan, Carolyn Snider, Michael Murray, Barry Harrison, Matt Kumar, Anita Baumgartner, Lynn Harstad, Anne Crory, Ellen Vlastelin, Roblec Allen, R. Steven Tharratt, Nick Satow, Yinpu Chen, Mark Hill, Theresa Lee, Anne Rudick, Timothy Gregory, Mark McCamish

Research output: Contribution to journalReview article

619 Citations (Scopus)

Abstract

Objectives: Recent studies in animal models of sepsis-induced acute respiratory distress syndrome (ARDS) have shown that a low-carbohydrate, high-fat diet combining the anti-inflammatory and vasodilatory properties of eicosapentaenoic acid (EPA; fish oil), γ-linolenic acid (GLA; borage oil) (EPA+GLA), and antioxidants improves lung microvascular permeability, oxygenation, and cardiopulmonary function and reduces proinflammatory eicosanoid synthesis and lung inflammation. These findings suggest that enteral nutrition with EPA+GLA and antioxidants may reduce pulmonary inflammation and may improve oxygenation and clinical outcomes in patients with ARDS. Design: Prospective, multicentered, double-blind, randomized controlled trial. Setting: Intensive care units of five academic and teaching hospitals in the United States. Patients: We enrolled 146 patients with ARDS (as defined by the American-European Consensus Conference) caused by sepsis/pneumonia, trauma, or aspiration injury in the study. Interventions: Patients meeting entry criteria were randomized and continuously tube-fed either EPA+GLA or an isonitrogenous, isocaloric standard diet at a minimum caloric delivery of 75% of basal energy expenditure x 1.3 for at least 4-7 days. Measurements and Main Results: Arterial blood gases were measured, and ventilator settings were recorded at baseline and study days 4 and 7 to enable calculation of PaO2/FIO2, a measure of gas exchange. Pulmonary neutrophil recruitment was assessed by measuring the number of neutrophils and the total cell count in bronchoalveolar lavage fluid at the same time points. Clinical outcomes were recorded. Baseline characteristics of 98 evaluable patients revealed that key demographic, physiologic, and ventilatory variables were similar at entry between both groups. Multiple bronchoalveolar lavages revealed significant decreases (~2.5-fold) in the number of total cells and neutrophils per mL of recovered lavage fluid during the study with EPA+GLA compared with patients fed the control diet. Significant improvements in oxygenation (PaO2/FIO2) from baseline to study days 4 and 7 with lower ventilation variables (FIO2, positive end-expiratory pressure, and minute ventilation) occurred in patients fed EPA+GLA compared with controls. Patients fed EPA+GLA required significantly fewer days of ventilatory support (11 vs. 16.3 days; p = .011), and had a decreased length of stay in the intensive care unit (12.8 vs. 17.5 days; p = .016) compared with controls. Only four of 51 (8%) patients fed EPA+GLA vs. 13 of 47 (28%) control patients developed a new organ failure during the study (p = .015). Conclusions: The beneficial effects of the EPA+GLA diet on pulmonary neutrophil recruitment, gas exchange, requirement for mechanical ventilation, length of intensive care unit stay, and the reduction of new organ failures suggest that this enteral nutrition formula would be a useful adjuvant therapy in the clinical management of patients with or at risk of developing ARDS.

Original languageEnglish (US)
Pages (from-to)1409-1420
Number of pages12
JournalCritical Care Medicine
Volume27
Issue number8
DOIs
StatePublished - Sep 6 1999

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alpha-Linolenic Acid
Eicosapentaenoic Acid
Adult Respiratory Distress Syndrome
Enteral Nutrition
Antioxidants
Intensive Care Units
Pneumonia
Neutrophil Infiltration
Gases
Diet
Lung
Ventilation
Sepsis
Neutrophils
Cell Count
Positive-Pressure Respiration
Eicosanoids
Fish Oils
Therapeutic Irrigation
Bronchoalveolar Lavage Fluid

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Effect of enteral feeding with eicosapentaenoic acid, γ-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. / Gadek, James E.; DeMichele, Stephen J.; Karlstad, Michael; Pacht, Eric R.; Donahoe, Michael; Albertson, Timothy E.; Van Hoozen, Chi; Wennberg, Ann K.; Nelson, Jeffrey L.; Noursalehi, Mojtaba; Drake, Jan; Farmer, Pat; Hart, Judy; Koetting-Freeman, Carol; Rague, Nancy; Cruz, Ed; Mucenski, Cathy; Morris, Steve; Gardener, Kathy; Moore, Mary; Whelan, Jay; Snider, Carolyn; Murray, Michael; Harrison, Barry; Kumar, Matt; Baumgartner, Anita; Harstad, Lynn; Crory, Anne; Vlastelin, Ellen; Allen, Roblec; Tharratt, R. Steven; Satow, Nick; Chen, Yinpu; Hill, Mark; Lee, Theresa; Rudick, Anne; Gregory, Timothy; McCamish, Mark.

In: Critical Care Medicine, Vol. 27, No. 8, 06.09.1999, p. 1409-1420.

Research output: Contribution to journalReview article

Gadek, JE, DeMichele, SJ, Karlstad, M, Pacht, ER, Donahoe, M, Albertson, TE, Van Hoozen, C, Wennberg, AK, Nelson, JL, Noursalehi, M, Drake, J, Farmer, P, Hart, J, Koetting-Freeman, C, Rague, N, Cruz, E, Mucenski, C, Morris, S, Gardener, K, Moore, M, Whelan, J, Snider, C, Murray, M, Harrison, B, Kumar, M, Baumgartner, A, Harstad, L, Crory, A, Vlastelin, E, Allen, R, Tharratt, RS, Satow, N, Chen, Y, Hill, M, Lee, T, Rudick, A, Gregory, T & McCamish, M 1999, 'Effect of enteral feeding with eicosapentaenoic acid, γ-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome', Critical Care Medicine, vol. 27, no. 8, pp. 1409-1420. https://doi.org/10.1097/00003246-199908000-00001
Gadek, James E. ; DeMichele, Stephen J. ; Karlstad, Michael ; Pacht, Eric R. ; Donahoe, Michael ; Albertson, Timothy E. ; Van Hoozen, Chi ; Wennberg, Ann K. ; Nelson, Jeffrey L. ; Noursalehi, Mojtaba ; Drake, Jan ; Farmer, Pat ; Hart, Judy ; Koetting-Freeman, Carol ; Rague, Nancy ; Cruz, Ed ; Mucenski, Cathy ; Morris, Steve ; Gardener, Kathy ; Moore, Mary ; Whelan, Jay ; Snider, Carolyn ; Murray, Michael ; Harrison, Barry ; Kumar, Matt ; Baumgartner, Anita ; Harstad, Lynn ; Crory, Anne ; Vlastelin, Ellen ; Allen, Roblec ; Tharratt, R. Steven ; Satow, Nick ; Chen, Yinpu ; Hill, Mark ; Lee, Theresa ; Rudick, Anne ; Gregory, Timothy ; McCamish, Mark. / Effect of enteral feeding with eicosapentaenoic acid, γ-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. In: Critical Care Medicine. 1999 ; Vol. 27, No. 8. pp. 1409-1420.
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title = "Effect of enteral feeding with eicosapentaenoic acid, γ-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome",
abstract = "Objectives: Recent studies in animal models of sepsis-induced acute respiratory distress syndrome (ARDS) have shown that a low-carbohydrate, high-fat diet combining the anti-inflammatory and vasodilatory properties of eicosapentaenoic acid (EPA; fish oil), γ-linolenic acid (GLA; borage oil) (EPA+GLA), and antioxidants improves lung microvascular permeability, oxygenation, and cardiopulmonary function and reduces proinflammatory eicosanoid synthesis and lung inflammation. These findings suggest that enteral nutrition with EPA+GLA and antioxidants may reduce pulmonary inflammation and may improve oxygenation and clinical outcomes in patients with ARDS. Design: Prospective, multicentered, double-blind, randomized controlled trial. Setting: Intensive care units of five academic and teaching hospitals in the United States. Patients: We enrolled 146 patients with ARDS (as defined by the American-European Consensus Conference) caused by sepsis/pneumonia, trauma, or aspiration injury in the study. Interventions: Patients meeting entry criteria were randomized and continuously tube-fed either EPA+GLA or an isonitrogenous, isocaloric standard diet at a minimum caloric delivery of 75{\%} of basal energy expenditure x 1.3 for at least 4-7 days. Measurements and Main Results: Arterial blood gases were measured, and ventilator settings were recorded at baseline and study days 4 and 7 to enable calculation of PaO2/FIO2, a measure of gas exchange. Pulmonary neutrophil recruitment was assessed by measuring the number of neutrophils and the total cell count in bronchoalveolar lavage fluid at the same time points. Clinical outcomes were recorded. Baseline characteristics of 98 evaluable patients revealed that key demographic, physiologic, and ventilatory variables were similar at entry between both groups. Multiple bronchoalveolar lavages revealed significant decreases (~2.5-fold) in the number of total cells and neutrophils per mL of recovered lavage fluid during the study with EPA+GLA compared with patients fed the control diet. Significant improvements in oxygenation (PaO2/FIO2) from baseline to study days 4 and 7 with lower ventilation variables (FIO2, positive end-expiratory pressure, and minute ventilation) occurred in patients fed EPA+GLA compared with controls. Patients fed EPA+GLA required significantly fewer days of ventilatory support (11 vs. 16.3 days; p = .011), and had a decreased length of stay in the intensive care unit (12.8 vs. 17.5 days; p = .016) compared with controls. Only four of 51 (8{\%}) patients fed EPA+GLA vs. 13 of 47 (28{\%}) control patients developed a new organ failure during the study (p = .015). Conclusions: The beneficial effects of the EPA+GLA diet on pulmonary neutrophil recruitment, gas exchange, requirement for mechanical ventilation, length of intensive care unit stay, and the reduction of new organ failures suggest that this enteral nutrition formula would be a useful adjuvant therapy in the clinical management of patients with or at risk of developing ARDS.",
author = "Gadek, {James E.} and DeMichele, {Stephen J.} and Michael Karlstad and Pacht, {Eric R.} and Michael Donahoe and Albertson, {Timothy E.} and {Van Hoozen}, Chi and Wennberg, {Ann K.} and Nelson, {Jeffrey L.} and Mojtaba Noursalehi and Jan Drake and Pat Farmer and Judy Hart and Carol Koetting-Freeman and Nancy Rague and Ed Cruz and Cathy Mucenski and Steve Morris and Kathy Gardener and Mary Moore and Jay Whelan and Carolyn Snider and Michael Murray and Barry Harrison and Matt Kumar and Anita Baumgartner and Lynn Harstad and Anne Crory and Ellen Vlastelin and Roblec Allen and Tharratt, {R. Steven} and Nick Satow and Yinpu Chen and Mark Hill and Theresa Lee and Anne Rudick and Timothy Gregory and Mark McCamish",
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month = "9",
day = "6",
doi = "10.1097/00003246-199908000-00001",
language = "English (US)",
volume = "27",
pages = "1409--1420",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
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TY - JOUR

T1 - Effect of enteral feeding with eicosapentaenoic acid, γ-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome

AU - Gadek, James E.

AU - DeMichele, Stephen J.

AU - Karlstad, Michael

AU - Pacht, Eric R.

AU - Donahoe, Michael

AU - Albertson, Timothy E.

AU - Van Hoozen, Chi

AU - Wennberg, Ann K.

AU - Nelson, Jeffrey L.

AU - Noursalehi, Mojtaba

AU - Drake, Jan

AU - Farmer, Pat

AU - Hart, Judy

AU - Koetting-Freeman, Carol

AU - Rague, Nancy

AU - Cruz, Ed

AU - Mucenski, Cathy

AU - Morris, Steve

AU - Gardener, Kathy

AU - Moore, Mary

AU - Whelan, Jay

AU - Snider, Carolyn

AU - Murray, Michael

AU - Harrison, Barry

AU - Kumar, Matt

AU - Baumgartner, Anita

AU - Harstad, Lynn

AU - Crory, Anne

AU - Vlastelin, Ellen

AU - Allen, Roblec

AU - Tharratt, R. Steven

AU - Satow, Nick

AU - Chen, Yinpu

AU - Hill, Mark

AU - Lee, Theresa

AU - Rudick, Anne

AU - Gregory, Timothy

AU - McCamish, Mark

PY - 1999/9/6

Y1 - 1999/9/6

N2 - Objectives: Recent studies in animal models of sepsis-induced acute respiratory distress syndrome (ARDS) have shown that a low-carbohydrate, high-fat diet combining the anti-inflammatory and vasodilatory properties of eicosapentaenoic acid (EPA; fish oil), γ-linolenic acid (GLA; borage oil) (EPA+GLA), and antioxidants improves lung microvascular permeability, oxygenation, and cardiopulmonary function and reduces proinflammatory eicosanoid synthesis and lung inflammation. These findings suggest that enteral nutrition with EPA+GLA and antioxidants may reduce pulmonary inflammation and may improve oxygenation and clinical outcomes in patients with ARDS. Design: Prospective, multicentered, double-blind, randomized controlled trial. Setting: Intensive care units of five academic and teaching hospitals in the United States. Patients: We enrolled 146 patients with ARDS (as defined by the American-European Consensus Conference) caused by sepsis/pneumonia, trauma, or aspiration injury in the study. Interventions: Patients meeting entry criteria were randomized and continuously tube-fed either EPA+GLA or an isonitrogenous, isocaloric standard diet at a minimum caloric delivery of 75% of basal energy expenditure x 1.3 for at least 4-7 days. Measurements and Main Results: Arterial blood gases were measured, and ventilator settings were recorded at baseline and study days 4 and 7 to enable calculation of PaO2/FIO2, a measure of gas exchange. Pulmonary neutrophil recruitment was assessed by measuring the number of neutrophils and the total cell count in bronchoalveolar lavage fluid at the same time points. Clinical outcomes were recorded. Baseline characteristics of 98 evaluable patients revealed that key demographic, physiologic, and ventilatory variables were similar at entry between both groups. Multiple bronchoalveolar lavages revealed significant decreases (~2.5-fold) in the number of total cells and neutrophils per mL of recovered lavage fluid during the study with EPA+GLA compared with patients fed the control diet. Significant improvements in oxygenation (PaO2/FIO2) from baseline to study days 4 and 7 with lower ventilation variables (FIO2, positive end-expiratory pressure, and minute ventilation) occurred in patients fed EPA+GLA compared with controls. Patients fed EPA+GLA required significantly fewer days of ventilatory support (11 vs. 16.3 days; p = .011), and had a decreased length of stay in the intensive care unit (12.8 vs. 17.5 days; p = .016) compared with controls. Only four of 51 (8%) patients fed EPA+GLA vs. 13 of 47 (28%) control patients developed a new organ failure during the study (p = .015). Conclusions: The beneficial effects of the EPA+GLA diet on pulmonary neutrophil recruitment, gas exchange, requirement for mechanical ventilation, length of intensive care unit stay, and the reduction of new organ failures suggest that this enteral nutrition formula would be a useful adjuvant therapy in the clinical management of patients with or at risk of developing ARDS.

AB - Objectives: Recent studies in animal models of sepsis-induced acute respiratory distress syndrome (ARDS) have shown that a low-carbohydrate, high-fat diet combining the anti-inflammatory and vasodilatory properties of eicosapentaenoic acid (EPA; fish oil), γ-linolenic acid (GLA; borage oil) (EPA+GLA), and antioxidants improves lung microvascular permeability, oxygenation, and cardiopulmonary function and reduces proinflammatory eicosanoid synthesis and lung inflammation. These findings suggest that enteral nutrition with EPA+GLA and antioxidants may reduce pulmonary inflammation and may improve oxygenation and clinical outcomes in patients with ARDS. Design: Prospective, multicentered, double-blind, randomized controlled trial. Setting: Intensive care units of five academic and teaching hospitals in the United States. Patients: We enrolled 146 patients with ARDS (as defined by the American-European Consensus Conference) caused by sepsis/pneumonia, trauma, or aspiration injury in the study. Interventions: Patients meeting entry criteria were randomized and continuously tube-fed either EPA+GLA or an isonitrogenous, isocaloric standard diet at a minimum caloric delivery of 75% of basal energy expenditure x 1.3 for at least 4-7 days. Measurements and Main Results: Arterial blood gases were measured, and ventilator settings were recorded at baseline and study days 4 and 7 to enable calculation of PaO2/FIO2, a measure of gas exchange. Pulmonary neutrophil recruitment was assessed by measuring the number of neutrophils and the total cell count in bronchoalveolar lavage fluid at the same time points. Clinical outcomes were recorded. Baseline characteristics of 98 evaluable patients revealed that key demographic, physiologic, and ventilatory variables were similar at entry between both groups. Multiple bronchoalveolar lavages revealed significant decreases (~2.5-fold) in the number of total cells and neutrophils per mL of recovered lavage fluid during the study with EPA+GLA compared with patients fed the control diet. Significant improvements in oxygenation (PaO2/FIO2) from baseline to study days 4 and 7 with lower ventilation variables (FIO2, positive end-expiratory pressure, and minute ventilation) occurred in patients fed EPA+GLA compared with controls. Patients fed EPA+GLA required significantly fewer days of ventilatory support (11 vs. 16.3 days; p = .011), and had a decreased length of stay in the intensive care unit (12.8 vs. 17.5 days; p = .016) compared with controls. Only four of 51 (8%) patients fed EPA+GLA vs. 13 of 47 (28%) control patients developed a new organ failure during the study (p = .015). Conclusions: The beneficial effects of the EPA+GLA diet on pulmonary neutrophil recruitment, gas exchange, requirement for mechanical ventilation, length of intensive care unit stay, and the reduction of new organ failures suggest that this enteral nutrition formula would be a useful adjuvant therapy in the clinical management of patients with or at risk of developing ARDS.

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U2 - 10.1097/00003246-199908000-00001

DO - 10.1097/00003246-199908000-00001

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JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

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