(464) Comparison of Lipid Formulations in Critically Ill Surgical Patients Receiving Parenteral Nutrition

Introduction: Parenteral nutrition (PN) is administered to critically ill patients who cannot tolerate enteral nutrition to treat or prevent malnutrition. When prescribing PN, clinicians may choose to administer either a soybean-based lipid (SL) a mixed lipid (ML) emulsion consisting of soybean, medium-chain triglyceride, olive, and fish oils. SL may contribute to systemic inflammation due to metabolism of omega-6 fatty acids and cause hepatotoxicity from sterol metabolism. ML emulsions may be more appropriate for critically ill patients, as they cause lower rates of inflammation and hepatotoxicity.

Methods: This was a single-center retrospective cohort study that included adult (age 18 or greater) critically ill surgical patients who received PN for at least 72 hours between January 2021 and June 2023. Patients were excluded if they were on PN prior to admission or received PN for less than 72 hours. Patients who received ML were compared to those who received SL. The primary outcome was intensive care unit (ICU) length of stay (LOS).

Results: After initial screening, 74 patients were included for final analysis. ML was used in 66% (n=49) patients and SL was used in 34% (n=25) of patients. Percent of goal calorie administration following PN initiation was similar in the ML group (88%) compared to the SL group (90%). Patients who received ML had a lower ICU LOS compared to patients who received SL (16 vs. 43.5 days, p=0.05). Patients who received ML were also less likely to be re-admitted to an ICU during the index admission (16.3% vs. 52%, p< 0.01) and had shorter overall hospital LOS (33 vs 52 days, p=0.05). There were no differences found in mortality, new hepatic dysfunction, or nosocomial infection.

Conclusions: Previous literature has demonstrated that use of ML instead of SL in critically ill patients may lead to lower ICU and hospital LOS. This study focused on critically ill surgical patients and found similar results. ML may be preferential over SL for use in critically ill patient populations.