Fish oil and sepsis we still need more trials.docVIP

Machado Critical Care 2011,15:449 /content/15/5/449 LET TER Fish oil and sepsis: we still need more trials Flavia R Machado* See related research by Pontes-Arruda et al., /content/15/3/R144 I read with concern the recently published article by Pontes-Arruda and colleagues addressing eicosapenta enoic acid/γ-linolenic acid (EPA/GLA) use in septic patients [1]. First, I did not ? nd an adequate sample size calculation ICU beds, mostly in public hospitals, so patients without organ dysfunction are not likely to be admitted. e patients’ baseline characteristics also draw attention, with high Sequential Organ Failure Assessment and we should know whether a type I error could have (SOFA) score, high Multiple Organ Dysfunction Score occurred. and hyperlactatemia. Organ dysfunction was one of the Another major concern is the inclusion imbalance exclusion criteria, with quite similar de? nitions to the e authors should therefore have provided e authors recognized that only ? ve a possible expla nation for this ? nding. e development among sites, which is not mentioned in the results or as a SOFA scor study limita sites included patients among the initial 12 selected sites. of organ dysfunction within the 48-hour window to the As the principal investigator of one of these centers start of enteral feeding is a possibility. However, this without inclusion, I believe it would be important to could compromise the results, as organ dysfunction mention that the ? rst author’s site included the vast would be already present by the time the intervention majority of patients. Although this is undoubtedly a took place. e strong criticism regarding the not yet published multicenter study, readers should analyze the results considering exactly how many patients were included EDEN