Role of omega-3 fatty acids in the prevention of delirium in mechanically ventilated patients

Taraneh Naghibi, Navid Shafigh, Saideh Mazloomzadeh, Taraneh Naghibi, Navid Shafigh, Saideh Mazloomzadeh

Abstract

Background: Inflammation is an important mechanism in the pathogenesis of delirium. Since delirium might reduce by anti-inflammatory effects of omega-3 fatty acids. Based on this respect, a study was conducted to indicate the effect of omega-3 fatty acids in the prevention of delirium in mechanically ventilated patients.

Materials and methods: This study is a randomized, double-blind, placebo-controlled clinical trial. One hundred and sixty-eight mechanically ventilated patients were selected in the investigation. Patients were randomly allocated to receive either 2 g of omega-3 syrup or placebo once a day. Twice daily delirium was assessed due to Confusion Assessment Method and the Richmond Agitation-Sedation Scale. The number of days with delirium during the first 10 days of admission was the primary outcome. Secondary outcomes had been included duration of mechanical ventilation, length of intensive care unit (ICU) stay, and mortality.

Results: Patient-days with delirium (P = 0.032), the number of ICU stay (P = 0.02), and mechanical ventilation (P = 0.042) days in omega-3 group significantly were lower than control group. Mortality was not significantly different between two groups.

Conclusion: Omega-3 fatty acids can reduce the risk of delirium in mechanically ventilated patients.

Keywords: Delirium; inflammation; intensive care unit; mechanical ventilation; omega-3 fatty acids.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2020 Journal of Research in Medical Sciences.

Figures

Figure 1
Figure 1
Flowchart of patients in the study

References

    1. Mehta S, Cook D, Devlin JW, Skrobik Y, Meade M, Fergusson D, et al. Prevalence, risk factors, and outcomes of delirium in mechanically ventilated adults. Crit Care Med. 2015;43:557–66.
    1. Adhikari NK, Fowler RA, Bhagwanjee S, Rubenfeld GD. Critical care and the global burden of critical illness in adults. Lancet. 2010;376:1339–46.
    1. Girard TD, Jackson JC, Pandharipande PP, Pun BT, Thompson JL, Shintani AK, et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med. 2010;38:1513–20.
    1. McAvay GJ, Van Ness PH, Bogardus ST, Jr, Zhang Y, Leslie DL, Leo-Summers LS, et al. Older adults discharged from the hospital with delirium: 1-year outcomes. J Am Geriatr Soc. 2006;54:1245–50.
    1. Gottesman RF, Grega MA, Bailey MM, Pham LD, Zeger SL, Baumgartner WA, et al. Delirium after coronary artery bypass graft surgery and late mortality. Ann Neurol. 2010;67:338–44.
    1. Koster S, Hensens AG, Schuurmans MJ, van der Palen J. Consequences of delirium after cardiac operations. Ann Thorac Surg. 2012;93:705–11.
    1. Cavallazzi R, Saad M, Marik PE. Delirium in the ICU: An overview. Ann Intensive Care. 2012;2:49.
    1. Brown CH, 4th, Probert J, Healy R, Parish M, Nomura Y, Yamaguchi A, et al. Cognitive decline after delirium in patients undergoing cardiac surgery. Anesthesiology. 2018;129:406–16.
    1. Sobbi SC, van den Boogaard M. Inflammation biomarkers and delirium in critically ill patients: New insights? Crit Care. 2014;18:153.
    1. Ritter C, Tomasi CD, Dal-Pizzol F, Pinto BB, Dyson A, de Miranda AS, et al. Inflammation biomarkers and delirium in critically ill patients. Crit Care. 2014;18:R106.
    1. Dillon ST, Vasunilashorn SM, Ngo L, Otu HH, Inouye SK, Jones RN, et al. Higher C-reactive protein levels predict postoperative delirium in older patients undergoing major elective surgery: A longitudinal nested case-control study. Biol Psychiatry. 2017;81:145–53.
    1. Miles EA, Calder PC. Influence of marine n-3 polyunsaturated fatty acids on immune function and a systematic review of their effects on clinical outcomes in rheumatoid arthritis. Br J Nutr. 2012;107(Suppl 2):S171–84.
    1. Mardani D, Bigdelian H. Prophylaxis of dexamethasone protects patients from further post-operative delirium after cardiac surgery: A randomized trial. J Res Med Sci. 2013;18:137–43.
    1. Calder PC. Marine omega-3 fatty acids and inflammatory processes: Effects, mechanisms and clinical relevance. Biochim Biophys Acta. 2015;1851:469–84.
    1. Jazayery A, Jalali M, Keshavarz SA, Shakouri Mahmoudabadi MM, Eshraghian MR, Saboor Yaraghi AA, et al. Inflammatory biomarkers, antioxidant enzyme activities, and oxidative stress in Iranian male patients with type 2 diabetes mellitus: Effects of eicosapentaenoic acid and Vitamin C supplementation. J Res Med Sci. 2012;17:S38–S41.
    1. Pourmasoumi M, Vosoughi N, Derakhshandeh-Rishehri SM, Assarroudi M, Heidari-Beni M. Association of omega-3 fatty acid and epileptic seizure in epileptic patients: A systematic review. Int J Prev Med. 2018;9:36.
    1. Shakeri J, Khanegi M, Golshani S, Farnia V, Tatari F, Alikhani M, et al. Effects of omega-3 supplement in the treatment of patients with bipolar I disorder. Int J Prev Med. 2016;7:77.
    1. Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU) JAMA. 2001;286:2703–10.
    1. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, et al. The Richmond agitation-sedation scale: Validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166:1338–44.
    1. Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, et al. Evaluation of delirium in critically ill patients: Validation of the confusion assessment method for the intensive care unit (CAM-ICU) Crit Care Med. 2001;29:1370–9.
    1. van den Boogaard M, Kox M, Quinn KL, van Achterberg T, van der Hoeven JG, Schoonhoven L, et al. Biomarkers associated with delirium in critically ill patients and their relation with long-term subjective cognitive dysfunction; indications for different pathways governing delirium in inflamed and noninflamed patients. Crit Care. 2011;15:R297.
    1. Girard TD, Ware LB, Bernard GR, Pandharipande PP, Thompson JL, Shintani AK, et al. Associations of markers of inflammation and coagulation with delirium during critical illness. Intensive Care Med. 2012;38:1965–73.
    1. Hughes CG, Morandi A, Girard TD, Riedel B, Thompson JL, Shintani AK, et al. Association between endothelial dysfunction and acute brain dysfunction during critical illness. Anesthesiology. 2013;118:631–9.
    1. McGrane S, Girard TD, Thompson JL, Shintani AK, Woodworth A, Ely EW, et al. Procalcitonin and C-reactive protein levels at admission as predictors of duration of acute brain dysfunction in critically ill patients. Crit Care. 2011;15:R78.
    1. Page VJ, Casarin A, Ely EW, Zhao XB, McDowell C, Murphy L, et al. Evaluation of early administration of simvastatin in the prevention and treatment of delirium in critically ill patients undergoing mechanical ventilation (MoDUS): A randomised, double-blind, placebo-controlled trial. Lancet Respir Med. 2017;5:727–37.
    1. Green P, Theilla M, Singer P. Lipid metabolism in critical illness. Curr Opin Clin Nutr Metab Care. 2016;19:111–5.
    1. Ishihara T, Yoshida M, Arita M. Omega-3 fatty acid-derived mediators that control inflammation and tissue homeostasis. Int Immunol. 2019;31:559–67.
    1. Martin JM, Stapleton RD. Omega-3 fatty acids in critical illness. Nutr Rev. 2010;68:531–41.
    1. Burkhart CS, Dell-Kuster S, Siegemund M, Pargger H, Marsch S, Strebel SP, et al. Effect of n-3 fatty acids on markers of brain injury and incidence of sepsis-associated delirium in septic patients. Acta Anaesthesiol Scand. 2014;58:689–700.
    1. Lu C, Sharma S, McIntyre L, Rhodes A, Evans L, Almenawer S, et al. Omega-3 supplementation in patients with sepsis: A systematic review and meta-analysis of randomized trials. Ann Intensive Care. 2017;7:58.
    1. Manzanares W, Langlois PL, Dhaliwal R, Lemieux M, Heyland DK. Intravenous fish oil lipid emulsions in critically ill patients: An updated systematic review and meta-analysis. Crit Care. 2015;19:167.
    1. Grau-Carmona T, Bonet-Saris A, García-de-Lorenzo A, Sánchez-Alvarez C, Rodríguez-Pozo A, Acosta-Escribano J, et al. Influence of n-3 polyunsaturated fatty acids enriched lipid emulsions on nosocomial infections and clinical outcomes in critically ill patients: ICU lipids study. Crit Care Med. 2015;43:31–9.
    1. Hall TC, Bilku DK, Al-Leswas D, Neal CP, Horst C, Cooke J, et al. A randomized controlled trial investigating the effects of parenteral fish oil on survival outcomes in critically ill patients with sepsis: A pilot study. JPEN J Parenter Enteral Nutr. 2015;39:301–12.
    1. Hamilton GM, Wheeler K, Di Michele J, Lalu MM, McIsaac DI. A systematic review and meta-analysis examining the impact of incident postoperative delirium on mortality. Anesthesiology. 2017;127:78–88.
    1. Reith FC, Van den Brande R, Synnot A, Gruen R, Maas AI. The reliability of the Glasgow coma scale: A systematic review. Intensive Care Med. 2016;42:3–15.
    1. Huang J, Xuan D, Li X, Ma L, Zhou Y, Zou H. The value of APACHE II in predicting mortality after paraquat poisoning in Chinese and Korean population: A systematic review and meta-analysis. Medicine (Baltimore) 2017;96:e6838.

Source: PubMed

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