الفهرس 
Acute Respiratory Distress Syndrome (ARDS)Only 14 pages are availabe for public view
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Abstract
Acute respiratory distress syndrome (ARDS) is a series of pulmonary insufficiency ranging from mild and easily correctable hypoxemia to severe refractory respiratory failure. The hallmark of ARDS is an increase in pulmonary capillary permeability resulting from epithelial and endothelial injury; a variety of inflammatory mediators are involved in the pathogenesis, including toxic oxygen radicals and metabolites of arachidonic acid (AA) derived from omega-6 PUFA.
The type of fatty acids (FA) that comprise the cell membrane of alveolar macrophages and neutrophils is influenced by dietary fat intake; this, in turn, impacts on the nature of eicosanoid mediators produced during ALI/ARDS.
Diets high in omega-6 fatty acids promote an inflammatory response by stimulating production of arachidonic acid and its derived eicosanoids. Omega-3 PUFA (found in fish oil) has anti-inflammatory effects by inhibiting of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), replacement of AA in the phospholipid membrane with a decrease in production of AA-derived eicosanoid inflammatory mediators by 40% to 70%, production of less inflammatory series of eicosanoids (PGE3 and LTB5), and production of resolvins, protectins, and maresins (lipid mediators derived from EPA and DHA with potent pro-resolving, and anti-inflammatory properties), which have been found to play an important role in the repair and resolution of inflammation.
Modulation of inflammation is one of the efforts, which help in attenuation and termination inflammatory cascade by nutritional supplementation with omega-3 fatty acids and antioxidant that can lessen the inflammatory response and be of therapeutic benefit in patients with ALI/ARDS.
The use of high lipid enteral diet enriched with EPA, GLA, and enhanced levels of antioxidant in patients with ARDS demonstrated a significant improvement not only in the oxygenation (PaO2/FiO2 ratio) but also in several outcomes such as ventilator free days, intensive care unit (ICU) free days and reduced new organ dysfunctions.
It is practical and safe to utilize EN instead of PN due to beneficial effects of EN when compared to PN if there is no contraindication for EN.
The administration of omega-3 PUFA, as fish oil (FO), offers a novel promising strategy to enrich nutrition regimes as it has been shown to modulate excessive inflammatory reactions by modulating the pro-inflammatory eicosanoid and prostaglandin E1 production.
Enteral fish oil given as a continuous infusion as part of complete nutrition improves outcome in critically ill patients, especially those ARDS. In contrast, the bolus administration of fish oil cannot be recommended as clinically beneficial in ARDS patients.
The therapeutic approach to ARDS was supportive. Positive results of human trials of fish oil based immunonutrition leave a little doubt as to the benefits of anti-inflammatory nutrients. Awareness of the differences in composition between the various immune formulas (fish oil containing formulas) is important, since inappropriate supplementation of certain types of immunonutrients may have adverse consequences.