In hospitalized patients,
lipid emulsions are an integral part of balanced
parenteral nutrition. Traditionally, a single
lipid source,
soybean oil, has been given to patients and was usually regarded as just a source of energy and to prevent essential
fatty-acid deficiency. However, mixtures of different
lipid emulsions have now become widely available, including mixtures of
soybean oil, medium-chain
triglycerides,
olive oil, and
fish oil.
Fish oil is high in the ω-3
polyunsaturated fatty acids docosahexaenoic acid (DHA) and
eicosapentaenoic acid (EPA). There is a growing body of evidence that these ω-3
fatty acids can exert beneficial immunomodulatory, anti-inflammatory, and
inflammation-resolution effects across a wide range of patient groups including surgical,
cancer, and
critically ill patients. At least in part, these effects are realized via potent specialized pro-resolution mediators (SPMs). Moreover,
parenteral nutrition including ω-3
fatty acids can result in additional clinical benefits over the use of standard
lipid emulsions, such as reductions in
infection rates and length of hospital and intensive care unit stay. Clinical and experimental evidence is reviewed regarding
lipid emulsion use in a variety of hospitalized patient groups, including surgical,
critically ill,
sepsis,
trauma, and
acute pancreatitis patients. Practical aspects of
lipid emulsion use in
critically ill patients are also considered, such as how to determine and fulfill energy expenditure, how and when to consider
parenteral nutrition, duration of infusion, and safety monitoring.