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The Impact of Intravenous Fat Emulsion Administration in Acute Lung Injury

Chemistry Department, Intensive Care Unit Department, and Department of Anatomy and Histology, Medical School, University of Ioannina, Ioannina, Greece

Correspondence and requests for reprints should be addressed to George Nakos, M.D., F.C.C.P., Intensive Care Unit, University Hospital of Ioannina, University Street, 45500 Ioannina, Greece. E-mail: gnakos{at}cc.uoi.gr

The aim of this study was to evaluate the effect of parenteral nutrition containing medium- and long-chain triglycerides on the function of the respiratory system and to investigate mechanisms involved in this process. We studied 13 patients with acute respiratory distress syndrome (ARDS), 8 receiving lipid and 5 placebo, and 6 without ARDS, receiving lipid. Bronchoalveolar lavage (BAL) was performed before and 1 hour after administration of lipid or placebo. In patients with ARDS, lipid administration resulted in deterioration of oxygenation (Pa_O2/FI_O2: from 129 ± 37 to 95 ± 42), compliance of respiratory system (from 39.2 ± 12 to 33.1 ± 9.2 ml/cm H₂O), and pulmonary vascular resistance (from 258 ± 47 to 321 ± 58 dyne·s·cm^-5). In the BAL fluid of the same group, an increase in total protein and phospholipid concentrations, phospholipase activities, platelet-activating factor and neutrophils, as well as alterations in BAL lipid profile were observed. No significant changes were observed in the control or in the ARDS-Placebo groups. In conclusion, this study indicates that administration of medium- and long-chain triglycerides in patients with ARDS causes alterations in lung function and hemodynamics. Inflammatory cells, possibly activated by lipids, release phospholipase A₂ and platelet-activating factor, enhancing edema formation, inflammation, and surfactant alterations.

Key Words: parenteral nutrition • medium-chain triglycerides/long-chain triglycerides • phospholipase A₂ • platelet-activating factor–acetylhydrolase • platelet-activating factor

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