Krista Haines, DO, MABMH
Assistant Professor of Surgery
Duke University, United States
Disclosure information not submitted.
Tetsu Ohnuma, MD, PhD
Assistant Professor of Anesthesiology
Duke University
Durham, North Carolina, United States
Disclosure information not submitted.
Vijay Krishnamoorthy, MD, PhD
Assistant Professor of Surgery
Duke University, United States
Disclosure information not submitted.
Karthik. Raghunathan, MD, MPH
Associate Professor of Anesthesiology
Duke University Hospital, United States
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.jpg "Paul Wischmeyer, MD, EDIC photo")
Paul Wischmeyer, MD, EDIC
Professor of Anesthesiology and Surgery
Duke University School of Medicine
Durham, North Carolina
Disclosure information not submitted.
Title: Hospital Change to SMOF Lipid Parenteral Nutrition in Critically Ill Adults Improves 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 patients receiving parenteral nutrition (PN), may improve clinical outcomes. The 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 patients pre- and post- health system 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 505 critically ill adults (age ≥18years) patients requiring PN. Our primary exposure was time-period (pre-switch/post-switch). We used multivariable regression models to examine the associations of pre-/post-switch to SMOF with outcomes including calorie delivery, liver function, infections, and length of hospital stay (LOS), adjusting for baseline characteristics.
Results: 26% of PN patients (n=129) received IL pre-switch and 74% received SMOF (n= 376) lipid PN post-switch. Patients in post-switch SMOF group were more acutely ill including a higher number admitted emergently (38% SMOF vs 32% IL, p< 0.001) and had more severe initial malnutrition diagnosis, including intestinal malabsorption (9% SMOF versus 6% IL) and malnutrition (65% SMOF versus 57% IL). Cumulative total calorie delivery was similar between time periods [median (IQR) 21,305 (10,126-33,436) calories pre-switch versus 19,218 (10,426-39,328) calories post-switch, p=0.68]. Significant reductions in change of maximal elevation of total bilirubin during hospitalization were noted in SMOF patients versus IL patients (p=0.04). No significant changes in AST, ALT, other liver function or infection rates were observed. Hospital LOS was significantly decreased post-switch to SMOF [median (IQR) 34 (23-47) days pre-switch versus 29 (18-48) days post-switch, p=0.04].
Conclusions: A switch to SMOF was successfully implemented among critically ill adults at Duke Hospital. Despite treating patients with more nutritional co-morbidities during the time period, the switch to SMOF showed a significant decrease in hospital length of stay and bilirubin while patients received similar amounts of calories.