가이드라인 별 lipid 권고 사항(ASPEN, ESPEN, Canadian)

 

 

SMOF lipid라는 4종류 지질 복합제가 국내에서 사용된 것은 고작 14년밖에 되지 않았다.

스모프리피드 20% 주의 허가일은 2006년 4월 7일이다. 심지어 미국 FDA에서는 2016년 7월 13일에 허가되었다. 
(2020.12.27 수정 : 2020년 > 2006년)

 

PN에서 사용되는 지질의 종류는 다음과 같다.

1) 대두유 ; soybean oil

2) 어유 ; fish oil

3) 올리브유 ; olive oil

4) 중결합트리글리세라이드 ; MCT, medium chain triglyceride 👉 일반 중성지방에 비해 용해도가 높고 지방조직에 중성지방의 형태로 저장되지 않으며 간 기능을 손상시키지 않는 장점

 

	soybean oil	fish oil	olive oil	MCT
250 ML	15 G	7.5 G	12.5 G	15 G
500 ML	30 G	15 G	25 G	30 G

 

 

ASPEN

H3b. Alternative IVFEs may provide outcome benefit over soy-based IVFEs; however, we cannot make a recommendation at this time due to lack of availability of these products in the United States. When these alternative IVFEs (SMOF [soybean oil, MCT, olive oil, and fish oil emulsion], MCT, OO, and FO) become available in the United States, based on expert opinion, we suggest that their use be considered in the critically ill patient who is an appropriate candidate for PN.

Grade: Very low

 

2015 Canadian

9.2. When parenteral nutrition with intravenous lipids is indicated, IV lipids that reduce the load of omega-6 fatty acids/soybean oil emulsions should be considered. However, there are insufficient data to make a recommendation on the type of lipids to be used that reduce the omega-6 fatty acid/soybean oil load in critically ill patients receiving parenteral nutrition.	Should be considered
10.2. In critically ill patients who are not malnourished, are tolerating some EN, or when PN is indicated for short term use (<10 days), withholding lipids high in soybean oil should be considered.	Should be considered
10.2. There are insufficient data to make a recommendation about withholding lipids high in soybean oil in critically ill patients who are malnourished or those requiring PN for long term (>10 days). Practitioners will have to weigh the safety and benefits of withholding lipids high in soybean oil on a case-by-case basis in these latter patient populations.	Insufficient data
10.3. There are insufficient data to make a recommendation on the use of lipids in total nutrient admixtures (TNA) vs. piggyback in critically ill patients.	Insufficient data

 

2019 ESPEN

The administration of intravenous lipid emulsions should be generally a part of PN.	GPP
Intravenous lipid (including non-nutritional lipid sources) should not exceed 1.5 g lipids/kg/day and should be adapted to individual tolerance	GPP
Parenteral lipid emulsions enriched with EPA & DHA (Fish oil dose 0.1-0.2 g/kg/d) can be provided in patients receiving PN.	0
ASPEN & SCCM do not acknowledge any advantage to new lipid emulsions	-

 

 

reference:

1) Yang, Soo Jin. "Lipids: Functional Effects and Clinical Application in Parenteral Nutrition." Surgical Metabolism and Nutrition 7.1 (2016): 1-6.

2) Singer, Pierre, et al. "ESPEN guideline on clinical nutrition in the intensive care unit." Clinical nutrition 38.1 (2019): 48-79.t5