Omega-3 fatty acid-containing parenteral nutrition in ICU patients: systematic review with meta-analysis and cost-effectiveness analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 33143750 · doi:10.1186/s13054-020-03356-w
What was done
A systematic review and meta-analysis of randomized controlled trials was conducted to compare omega-3 fatty acid-containing parenteral nutrition (PN) against standard PN in adult intensive care unit (ICU) patients receiving at least 70% of total energy requirements via PN. Analyses were performed for the overall ICU cohort and a subgroup with mean ICU stay >48 hours. Co-primary endpoints were infection and mortality rates, alongside ICU and hospital length of stay (HLOS). Pooled clinical efficacy estimates were then used to model hospital episode costs across six healthcare systems (France, Germany, Italy, Spain, UK, and US).
What was found
In adult ICU patients, omega-3 PN significantly decreased infection risk (RR 0.62; 95% CI 0.45 to 0.86; p = 0.004), HLOS (-3.05 days; 95% CI -5.03 to -1.07; p = 0.003), and ICU stay (-1.89 days; 95% CI -3.33 to -0.45; p = 0.01). In patients staying >48 hours in the ICU, omega-3 PN similarly reduced infections (RR 0.65; 95% CI 0.46 to 0.94; p = 0.02), HLOS (-3.98 days; 95% CI -6.90 to -1.06; p = 0.008), and ICU stay (-2.14 days; 95% CI -3.89 to -0.40; p = 0.02). Mortality results were specified as a co-primary outcome but no numerical data or findings were reported in the abstract. Modeled overall hospital costs decreased in all evaluated countries, ranging from savings of €-3156 ± 1404 in Spain to €-9586 ± 4157 in the US.
Why it matters
This study provides evidence that substituting standard PN with omega-3-enriched lipid emulsions in adult ICU patients improves infection and stay duration outcomes while generating net hospital cost savings across multiple health systems.
Limits
The abstract does not state the number of included trials, total participant count, or specific mortality results despite listing mortality as a co-primary endpoint. Economic findings are derived from pharmacoeconomic simulations rather than direct prospective cost tracking.
Cited by
- partial A meta-analysis found that parenteral omega-3 supplementation in hospitalized patients reduces ICU length of stay and decreases mortality by up to 60%.