Enteral nutrition vs. TPN
Second, a major ARDS (Acute Respiratory Distress Syndrome) Network Trial—the OMEGA study– was recently published in JAMA (2, 3). The network conducted a phase 3 trial to study the efficacy of fatty acid/antioxidant supplementation in improving outcome in acute lung injury. 272 patients enrolled–143 randomized to Omega-3 fatty acid + antioxidant supplementation and 129 placebo. The supplement or control was given BID and continued through day 21. Patients received standard ARDS Network lung protective ventilation, glycemic control, and fluid management. The trial was halted after the 1st interim analysis. Ventilator-free days (primary endpoint) were fewer in the omega-3 fatty acid supplement group– suggesting no benefit and possible harm. A trend toward higher mortality was seen in the supplement group as well. The therapy caused a biologic effect seen in elevated serum fatty acid levels. However, inflammatory markers, ventilatory parameters, and outcome (ventilator-free days) did not improve. There was insufficient power to determine harm from omega-3 supplementation.