.jpg "Paul Wischmeyer, MD, EDIC photo")
Paul Wischmeyer, MD, EDIC
Professor of Anesthesiology and Surgery
Duke University School of Medicine
Durham, North Carolina
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Tetsu Ohnuma, MD, PhD
Assistant Professor of Anesthesiology
Duke University
Durham, North Carolina, United States
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Vijay Krishnamoorthy, MD, PhD
Assistant Professor of Surgery
Duke University, United States
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Karthik. Raghunathan, MD, MPH
Associate Professor of Anesthesiology
Duke University Hospital, United States
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Krista Haines, DO, MABMH
Assistant Professor of Surgery
Duke University, United States
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Title: Hospital Change To SMOF Lipid Parenteral Nutrition In The Pediatric ICU Improves Clinical Outcomes
Introduction: Early data suggests use of a balanced lipid emulsion containing Soybean oil, Medium-chain Triglycerides (MCT), Olive Oil, and Fish Oil (SMOF) in adult patients receiving parenteral nutrition (PN) may improve clinical outcomes, although limited data exist in critically ill pediatric patients. Duke University Hospital made a full switchover to SMOF balanced lipids in 05/2017 from pure soybean oil (omega-6) intralipid (IL). We examined patient characteristics, length of stay, and liver function in critically ill children pre- and post- hospital change to SMOF from IL as a PN component.
Methods: We conducted a retrospective study from 2016-2019, for one-year pre-SMOF switch and 2 years following switch to SMOF in critically ill children (from one month to 17 years) requiring PN. Our primary exposure was time period (pre-switch and post-switch). We used multivariable regression models to examine adequacy of nutrition delivery (calorie delivery), infections, and length of stay (LOS), adjusting for baseline characteristics.
Results: Among 379 critically-ill children treated from 2016-2019, 27% of PN patients (n=101) were treated in the pre-switch period and 73% of PN patients (n= 278) were treated in the post-switch period. Patients in both groups were similar in age (4.2±5.5 years IL; 3.9±5.0 yeas SMOF, p=0.60) and BMI (17.5±3.2 IL; 17.6±3.7 SMOF, p=0.78). Crude cumulative total calorie delivery (p=0.86) and protein delivery (p=0.64) were also similar between time periods. In multivariable regression models, pneumonia rates were significantly reduced in post-switch patients versus pre-switch period (Odds Ratio 0.24; CI (0.07, 0.88), p=0.03). Trends to reduced bacteremia/sepsis and all-cause infection were also observed (p=0.099 and p=0.091 respectively). Switch to SMOF lipid was associated with a 27% reduction in hospital LOS (p < 0.0001).
Conclusions: A switch to SMOF lipid was successfully implemented among critically ill pediatric patients at Duke Hospital in 2017. The switch to SMOF showed a significant decrease in pneumonia and hospital length of stay while patients received similar amounts of protein and calories. This is the first data, to our knowledge, demonstrating improved clinical outcomes in pediatric ICU patients following a switch to SMOF-lipid from IL.