How to select lipid emulsions for children with critical illness / 中国小儿急救医学

ABSTRACT

Intravenous lipid emulsions( LEs) are relevant for patients receiving parenteral nutrition because they prevent the depletion of essential fatty acids(FAs) and as a highly dense energy source. The prescription of LEs is complex,due mainly to their distinct FAs components,which may alter the immune re-sponse in different ways and distinctly influence inflammation according to their biochemical properties. The patient′s metabolic profile should guide the type of FAs and amount of lipids that are provided. For critically ill hypermetabolic patients,growing evidence indicates that standard LEs based solely on soybean oil should be avoided in favor of new LEs containing medium-chain triglycerides,olive oil,or fish oil to decrease the provision of potentially inflammatory/immunosuppressiveω-6 polyunsaturated fatty acids. As sources of eico-sapentaenoic and docosahexaenoic acids,LEs containing fish oil may be important for critically ill patients be-cause they allow better modulation of the immune response and likely reduce the length of intensive care unit stay. However,current evidence precludes the recommendation of a specific LE for clinical use in this patient population.