11951
document
Enteral nutrition with eicosapentaenoic acid , gamma-linolenic acid , and antioxidants reduces alveolar inflammatory mediators and protein influx in patients with acute respiratory distress syndrome . OBJECTIVE Previously , we showed that acute respiratory distress syndrome patients fed an enteral diet containing eicosapentaenoic acid and gamma-linolenic acid and elevated antioxidants ( EPA+GLA ; Oxepa ) had significantly reduced pulmonary inflammation , increased oxygenation , and improved clinical outcomes . In a subset of acute respiratory distress syndrome patients from this trial , we performed a preliminary examination of the potential mechanisms underlying these clinical improvements by retrospectively testing the hypothesis that enteral feeding with EPA+GLA could reduce alveolar-capillary membrane protein permeability and the production of interleukin ( IL ) -8 , IL-6 , tumor necrosis factor-alpha , and leukotriene B4 that are responsible , in part , for pulmonary inflammation . DESIGN Prospective , randomized , double-blind , controlled clinical trial . SETTING Intensive Care Unit of the Ohio State University Medical Center . PATIENTS A total of 67 patients were enrolled who met defined criteria for acute lung injury/acute respiratory distress syndrome . INTERVENTIONS A total of 43 of 67 evaluable patients randomly received either EPA+GLA or an isonitrogenous , isocaloric standard diet that was tube fed at a minimum caloric delivery of 75 % of basal energy expenditure times 1.33 for at least 4 to 7 days . MEASUREMENTS AND MAIN RESULTS Bronchoalveolar lavage ( BAL ) was performed at baseline and study days 4 and 7 to obtain BAL fluid ( BALF ) for measurement of total protein , ceruloplasmin , and transferrin , total neutrophil count , IL-8 , IL-6 , tumor necrosis factor-alpha , and leukotriene B4 . Oxygenation , measured as Pao2/Fio2 , was assessed before BAL . Patients fed EPA+GLA had a significant reduction in BALF ceruloplasmin and IL-8 during the study as compared with patients fed the control diet . BALF levels of total protein , neutrophils , and leukotriene B4 tended to decrease in EPA+GLA patients over the course of the study as compared with control patients . BALF levels of IL-6 declined similarly during the study in both groups . A trend toward a reduction in BALF tumor necrosis factor-alpha was observed on study day 7 in the EPA+GLA group as compared with control patients . Significant improvements in oxygenation ( Pao2/Fio2 ) occurred in EPA+GLA patients on study day 4 as compared with controls . Correlation analysis revealed significant relationships between BALF neutrophil counts and indices of alveolar-capillary membrane protein permeability , IL-8 , and leukotriene B4 . CONCLUSIONS This preliminary investigation showing a decrease in BALF levels of IL-8 and leukotriene B4 and the associated reduction of BALF neutrophils and alveolar membrane protein permeability in acute respiratory distress syndrome patients fed EPA+GLA support , in part , the potential mechanisms underlying the previously described clinical improvements with this diet . Additional controlled studies are needed to confirm these findings .
11952
Intervention_Pharmacological
eicosapentaenoic acid , gamma-linolenic acid
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Intervention_Pharmacological
antioxidants
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Intervention_Pharmacological
eicosapentaenoic acid
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Intervention_Pharmacological
gamma-linolenic acid
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Intervention_Pharmacological
antioxidants
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Intervention_Pharmacological
isonitrogenous
11958
Intervention_Pharmacological
EPA+GLA
11959
Outcome_Other
Bronchoalveolar lavage ( BAL )
11960
Outcome_Physical
total protein
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Outcome_Physical
ceruloplasmin
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Outcome_Physical
transferrin
11963
Outcome_Physical
total neutrophil count
11964
Outcome_Physical
IL-8
11965
Outcome_Physical
IL-6 , tumor necrosis factor-alpha
11966
Outcome_Physical
leukotriene B4
11967
Outcome_Physical
Oxygenation
11968
Outcome_Physical
BALF ceruloplasmin
11969
Outcome_Physical
IL-8
11970
Outcome_Physical
total protein
11971
Outcome_Physical
neutrophils
11972
Outcome_Physical
leukotriene B4
11973
Outcome_Physical
IL-6
11974
Outcome_Physical
tumor necrosis factor-alpha
11975
Outcome_Physical
oxygenation
11976
Outcome_Physical
neutrophil
11977
Outcome_Physical
leukotriene
11978
Participant_Condition
in patients with acute respiratory distress syndrome .
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Participant_Condition
acute respiratory distress syndrome patients
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Participant_Condition
acute respiratory distress syndrome patients