Lipid Emulsions in Sepsis and SIRS

SIRS and sepsis are diseases with alternating hyper-and hypo-inflammatory phases in spite of major advances in intensive care medicine being associated with high rates of mortality. Lipid emulsions are the mainstay of nutrional therapy as septic patients often present with the need for parenteral nutrition and their metabolic response has changed to the oxidation of lipids. Lipid emulsions have a massive impact of the immune system of septic patients next to their function of serving as caloric support and building blocks for the cell membrane. Infusion of LCTbased emulsions may either increase the immunosuppression or hyper-inflammation in septic patients. A possible reason for this is the increased supply and availability of n-6 polyunsaturated fatty acids. The use of LCT/MCT-or olive oil-based emulsions may be an option to reduce the supply of polyunsaturated fatty acids. N-3 fatty acids are alternative precursors for the synthesis of prostaglandins, thromboxane, and leukotrienes; their integration into infusion therapy offers the advantage of reducing n-6 polyunsaturated fatty acids in the used emulsions. A further benefit is the shift of the n-6/n-3 ratio to a more immuno-neutral proportion. Both changes may be of benefit for the parenteral nutrition of septic patients.