Could early infusion of fish-oil-based lipid emulsion affect the need for intensive care in moderately diseased COVID-19 patients? A randomized clinical trial

Abstract

Abstract Background Sixty moderate diseased COVID-19 patients were divided into two equal groups and were enrolled in a randomized double-blind clinical trial. Group C was delivered standard enteral nutrition plus 100 ml/day of 0.9% normal saline. Group L was delivered fish-oil-based lipid emulsion (FOBLE) supplementation to standard enteral nutrition at a dose of 100 ml/day. Both groups infused at a rate of 12.5 ml/h over 8 h for 5 days. We aimed to compare the effect of FOBLE versus placebo in COVID-19 disease to clarify the impact on the number of patients shifted to the ICU, oxygenation, inflammatory markers, and short-term outcomes (7 days). Results The failed conventional care and shift to ICU was significantly lower in group L in comparison to group C (six patients (20.0%) versus 14 patients (46.7%) shifted to ICU, P-value = 0.028). The inflammatory markers were determined and evaluated. Throughout the trial, there were no significant changes with the exception of the 7th day neutrophil/lymphocyte ratio (NLR), when the ratio was lower in group L than in group C (6.10 (3.90–7.20) versus 9.65 (8.30–10.90), respectively, P-value 0.001). Conclusions In moderate diseased COVID-19 patients, early administration of parenteral FOBLE as an adjuvant to enteral feeding reduces shifts and so minimizes the burden on the ICU. Trial registration ClinicalTrials.gov PRS ( NCT04957940 ). Registered on 5 July 2021.

Keywords

• COVID-19
• Enteral nutrition
• Fish-oil-based lipid emulsion
• Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2)
• Shift to ICU
• SMOF lipid 20%