2011 Oct 9 - Pharmaconutrition in Acute Lung Injury
Deborah J. Cook, Daren K. Heyland Published online October 5, 2011. doi: 10.1001/jama.2011.1470
During the last decade, there has been a major conceptual shift in thinking about artificial nutrition provided to critically ill patients. Because of its modulating effect on pathophysiology and emerging evidence about potential effects on clinical outcomes, nutrition is now considered “therapy” and not simply “supportive care.” For example, arginine-supplemented diets are associated with reduced infections and lengths of hospital stay in patients undergoing elective operations,
1 glutamine-supplemented parenteral nutrition is associated with reduced infection and mortality in critically ill patients,
2 and antioxidant supplementation is associated with reduced mortality among critically ill patients with systemic inflammation.
3 The new model of “pharmaconutrition” calls for trials examining the dose, route, timing, and duration of each intervention, focusing on whether the intervention is designed to restore an existing deficiency, reduce ongoing loss of an expended substrate, and/or provide supratherapeutic exposure.
In this issue of JAMA, Rice and colleagues,
4 writing for the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network, report the results from the OMEGA clinical trial involving patients with acute lung injury, who were randomized to receive either placebo or a supplement comprising the omega-3 fatty acids docosahexaenoic and eicosapentaenoic acid, γ-linolenic acid, and antioxidants. The hypothesis was that the pharmaconutrient supplement would increase ventilator-free days (the primary outcome), favorably influence inflammation, and have other salutary effects on clinical end points. Rigorous features of this trial are the concealed allocation, blinding, standardization of important cointerventions related to ventilation and other care management, high compliance, an a priori analysis plan, adherence to the intention-to-treat principle, and excellent follow-up.
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