Oxepa

Hello everyone!
I learned a little bit yesterday and today about the controversy surrounding Oxepa, which is the formula used in respiratory stressed patients at CMC as it is low CHO. I learned about calculating the PO2/%FIO2 (from the vent settings) and then if this ratio is <200 then the person is in ARDS and if it is <300 then the patient is considered in acute lung injury. Traditionally, the dietitians in trauma would use Oxepa if the ratio was <200. However, some new studies apparently came out which demonstrated that there is a higher mortality rate and a higher amount of time on the vent with this formula. They believe that it is due to the Omega 3 fatty acids found in Oxepa. They are in there because of their benefit with inflammation, but they seem to possibly do more harm than good. The dietitians and doctors in the STICU are now unsure of what to do in ARDS patients because of these studies, because as I recall from MNT, using a high CHO formula makes it harder for the pt to "breathe off" the CO2 and could make the resipiratory distress worse. Oxepa only has 105 Gm CHO/liter (as opposed to around 200 in standard formulas) so it seems like if the Omega 3 fatty acids are the problem then they should be removed from the formula and then studies should demonstrate whether or not the low CHO formula plays a beneficial role in ARDS. I was just curious as to whether or not any of you have come across any studies, or if you know what your hospital's policy is. It seems as though CMC is at a recent crossroads with this! Email me or post if you have any insight!
In other news, I'm in GI/Surgery this week mostly and so I've gotten to do a crazy amount of PPNs/TPNs and am loving the practice. Between the dietitian that Im rotating with and myself, we did 11 today! I recently learned that if Bilirubin is >10 then the policy at CMC is to alter the trace elements in the TPN since liver function is down, so just something ya'll might want to note in case your hospitals have similar policies.

Elizabeth