Omega-3 fatty acids for acute lung injury/ARDS are useless-to-harmful (OMEGA RCT, JAMA) - PulmCCM
Advertisement
Jan 012012
 

Numerous small (n~100), single-center randomized trials have shown a benefit of omega-3 fatty acids in acute lung injury and ARDS (reduced mortality, length of stay, and organ failure; improved oxygenation and respiratory mechanics). A meta-analysis combining these studies suggested a stat.significant benefit in mortality (risk ratio 0.67), ventilator requirement (-5 days), and ICU stay (-4 days).

In JAMA, Rice et al pop the balloon … and something about those earlier trials suddenly smells fishy. In the NHLBI-funded OMEGA study, they randomized 272 adults with ALI/ARDS to receive either twice daily omega-3 fatty acids plus antioxidants, or placebo.

OMEGA was stopped early for futility, which may have been an understatement: the intervention patients had 3 fewer ventilator-free days (p=0.02), 3 more days in the ICU (p=0.04), and an absolute 10% increase in mortality (26.6% vs. 16.3%, p=0.054, just barely not stat.significant).

Unbelievably, an accompanying editorial tries to put a positive spin on this and repair the damage, proposing various theoretical and (to me) flimsy ways that omega-3s might still be helpful for ALI, and going so far as to call for “a broad, bold research agenda” for the field of “pharmaconutrition” in general. I don’t want to be a hater, but do we need any more trials like this one? Just don’t enroll my Grandma, please …

Rice TW et al. Enteral Omega-3 Fatty Acid, Y-Linolenic Acid, and Antioxidant Supplementation in Acute Lung Injury. JAMA ePub October 5, 2011. 

More commentary on Scott Aberegg’s excellent Medical Evidence Blog.

 

Liked this post? Get a weekly email update (no spam, ever), and explore our library of pulmonary and critical care guidelines, practice updates and review articles.

PulmCCM is an independent publication, not affiliated with or endorsed by any other organization, society and/or journal referenced on the website.

Leave a Comment