{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T11:12:30Z","timestamp":1773745950124,"version":"3.50.1"},"reference-count":50,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background and Aims: Injectable lipid emulsions are an integral component of parenteral nutrition, providing energy as well as essential fatty acids. However, conventional soybean oil\u2013based emulsions, which are rich in omega-6 fatty acids, are associated with a risk of exacerbating pro-inflammatory responses and immunosuppression, which is of particular importance in critically ill patients. The aim of this review is to present the significance of the composition of modern injectable lipid emulsions, with particular emphasis on emulsions containing fish oil as a source of omega-3 fatty acids (EPA and DHA), and to discuss their potential clinical benefits in selected critical conditions. Methods: This narrative review discusses the rationale for modern mixed-oil ILE, with a focus on fish oil as a source of EPA and DHA, and summarizes potential clinical benefits in selected critical care settings. Results: Modern injectable lipid emulsions combine long-chain triglycerides derived from soybean oil (omega-6), MCTs, olive oil (omega-9), and fish oil (omega-3). Adjusting the supply of individual fractions affects cell membrane structure, signaling pathways, gene expression, and the profile of lipid mediators produced, including specialized pro-resolving mediators (SPMs). ESPEN guidelines and international recommendations emphasize the need to use lipids in parenteral nutrition, preferring mixed-oil ILE supplemented with fish oil. The cited meta-analyses and clinical studies indicate that omega-3-containing emulsions may reduce the risk of infections and sepsis; shorten hospital stay, ICU length of stay, and duration of mechanical ventilation in patients with sepsis; as well as improve outcomes in acute pancreatitis; lower the risk of delirium; and reduce the incidence of delayed gastric emptying. Conclusions: Available data support the use of mixed-oil ILE supplemented with fish oil in the parenteral nutrition of critically ill patients as a strategy with immunomodulatory and pro-resolving potential that may translate into improved clinical outcomes. However, further well-designed randomized trials are needed to optimize dosing and administration regimens.<\/jats:p>","DOI":"10.3390\/nu18060939","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T10:21:41Z","timestamp":1773742901000},"page":"939","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fish Oil-Containing Injectable Lipid Emulsions in Parenteral Nutrition: Immunomodulation and Clinical Outcomes in Critically Ill Patients\u2014Narrative Review"],"prefix":"10.3390","volume":"18","author":[{"given":"Mariusz","family":"K\u0119ska","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland"},{"name":"Clinical Department of Anaesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, 10-045 Olsztyn, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milena","family":"K\u0119ska","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland"},{"name":"Clinical Department of Anaesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, 10-045 Olsztyn, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1436-4369","authenticated-orcid":false,"given":"Miros\u0142aw","family":"Perli\u0144ski","sequence":"additional","affiliation":[{"name":"Fresenius Kabi Poland, Aleje Jerozolimskie 134, 02-305 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piotr","family":"Pabich","sequence":"additional","affiliation":[{"name":"Hospital Pharmacy, Regional Specialist Hospital in Olsztyn, 10-045 Olsztyn, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dariusz","family":"Onichimowski","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland"},{"name":"Clinical Department of Anaesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, 10-045 Olsztyn, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Klek, S. (2016). Omega-3 Fatty Acids in Modern Parenteral Nutrition: A Review of the Current Evidence. J. Clin. Med., 5.","DOI":"10.3390\/jcm5030034"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Raman, M., Almutairdi, A., Mulesa, L., Alberda, C., Beattie, C., and Gramlich, L. (2017). Parenteral Nutrition and Lipids. Nutrients, 9.","DOI":"10.3390\/nu9040388"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"600","DOI":"10.3945\/an.115.009084","article-title":"Intravenous Lipid Emulsions in Parenteral Nutrition","volume":"6","author":"Fell","year":"2015","journal-title":"Adv. Nutr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.clnu.2017.08.032","article-title":"Lipids in the intensive care unit: Recommendations from the ESPEN Expert Group","volume":"37","author":"Calder","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1007\/s00134-009-1744-5","article-title":"Lipid emulsions in parenteral nutrition of intensive care patients: Current thinking and future directions","volume":"36","author":"Calder","year":"2010","journal-title":"Intensive Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1177\/0148607106030004351","article-title":"New parenteral lipid emulsions for clinical use","volume":"30","author":"Waitzberg","year":"2006","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"18S","DOI":"10.1177\/0148607115595980","article-title":"Functional Roles of Fatty Acids and Their Effects on Human Health","volume":"39","author":"Calder","year":"2015","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1002\/jpen.1672","article-title":"\u03c9-3 Fatty-Acid Enriched Parenteral Nutrition in Hospitalized Patients: Systematic Review with Meta-Analysis and Trial Sequential Analysis","volume":"44","author":"Pradelli","year":"2020","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1038\/nature13479","article-title":"Pro-resolving lipid mediators are leads for resolution physiology","volume":"510","author":"Serhan","year":"2014","journal-title":"Nature"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2657","DOI":"10.1172\/JCI97943","article-title":"Resolvins in inflammation: Emergence of the pro-resolving superfamily of mediators","volume":"128","author":"Serhan","year":"2018","journal-title":"J. Clin. Investig."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/j.bbalip.2014.08.006","article-title":"Protectins and maresins: New pro-resolving families of mediators in acute inflammation and resolution bioactive metabolome","volume":"1851","author":"Serhan","year":"2015","journal-title":"Biochim. Biophys. Acta"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1093\/intimm\/dxz001","article-title":"Omega-3 fatty acid-derived mediators that control inflammation and tissue homeostasis","volume":"31","author":"Ishihara","year":"2019","journal-title":"Int. Immunol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"160","DOI":"10.3389\/fimmu.2016.00160","article-title":"Resolution of Inflammation: What Controls Its Onset?","volume":"7","author":"Sugimoto","year":"2016","journal-title":"Front. Immunol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1016\/j.clnu.2023.07.011","article-title":"ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit","volume":"42","author":"Singer","year":"2023","journal-title":"Clin. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1038\/ejcn.2016.167","article-title":"Relevance of non-nutritional calories in mechanically ventilated critically ill patients","volume":"70","author":"Bousie","year":"2016","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e23699","DOI":"10.1096\/fj.202400619R","article-title":"Expert consensus report on lipid mediators: Role in resolution of inflammation and muscle preservation","volume":"38","author":"Serhan","year":"2024","journal-title":"FASEB J."},{"key":"ref_17","first-page":"1","article-title":"The use of intravenous emulsions containing omega-3 unsaturated fatty acids in clinical practice: Recommendations of a team of experts","volume":"97","author":"Sobocki","year":"2024","journal-title":"Pol. J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1016\/j.clnu.2023.02.008","article-title":"Omega-3 fatty acids in parenteral nutrition\u2014A systematic review with network meta-analysis on clinical outcomes","volume":"42","author":"Pradelli","year":"2023","journal-title":"Clin. Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"tkac012","DOI":"10.1093\/burnst\/tkac012","article-title":"Effects of fish oil-containing nutrition supplementation in adult sepsis patients: A systematic review and meta-analysis","volume":"10","author":"Wang","year":"2022","journal-title":"Burn. Trauma"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/gutjnl-2012-302779","article-title":"Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis\u20142012: Revision of the Atlanta classification and definitions by international consensus","volume":"62","author":"Banks","year":"2013","journal-title":"Gut"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1002\/bjs.6447","article-title":"Dutch Acute Pancreatitis Study Group. Timing and impact of infections in acute pancreatitis","volume":"96","author":"Besselink","year":"2009","journal-title":"Br. J. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1056\/NEJMoa0908821","article-title":"A step-up approach or open necrosectomy for necrotizing pancreatitis","volume":"362","author":"Besselink","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1001\/jama.2017.13836","article-title":"Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009\u20132014","volume":"318","author":"Rhee","year":"2017","journal-title":"JAMA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2711","DOI":"10.1016\/j.clnu.2018.04.003","article-title":"Intravenous omega-3 fatty acids are associated with better clinical outcome and less inflammation in patients with predicted severe acute pancreatitis: A randomised double blind controlled trial","volume":"39","author":"Eltweri","year":"2020","journal-title":"Clin. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2686","DOI":"10.1016\/j.clnu.2019.12.006","article-title":"Are omega-3 fatty acids safe and effective in acute pancreatitis or sepsis? A systematic review and meta-analysis","volume":"39","author":"Wolbrink","year":"2020","journal-title":"Clin. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1177\/0148607108316189","article-title":"Omega-3 fatty acids-supplemented parenteral nutrition decreases hyperinflammatory response and attenuates systemic disease sequelae in severe acute pancreatitis: A randomized and controlled study","volume":"32","author":"Wang","year":"2008","journal-title":"JPEN"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.clnu.2004.12.008","article-title":"Effect of enterally administered n-3 polyunsaturated fatty acids in acute pancreatitis--A prospective randomized clinical trial","volume":"24","author":"Lasztity","year":"2005","journal-title":"Clin. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1007\/s10753-009-9136-0","article-title":"Fish oil-supplemented parenteral nutrition in severe acute pancreatitis patients and effects on immune function and infectious risk: A randomized controlled trial","volume":"32","author":"Wang","year":"2009","journal-title":"Inflamation"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1097\/CCM.0000000000004139","article-title":"Biomarkers of Delirium Duration and Delirium Severity in the ICU","volume":"48","author":"Khan","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e1260","DOI":"10.1212\/WNL.0000000000008164","article-title":"Clinical EEG slowing correlates with delirium severity and predicts poor clinical outcomes","volume":"93","author":"Kimchi","year":"2019","journal-title":"Neurology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1177\/1099800419849489","article-title":"Structural Brain Changes in Delirium: An Integrative Review","volume":"21","author":"Kalvas","year":"2019","journal-title":"Biol. Res. Nurs."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1186\/cc13930","article-title":"Inflammation biomarkers and delirium in critically ill patients: New insights?","volume":"18","author":"Sobbi","year":"2014","journal-title":"Crit. Care"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1001\/archneur.1992.00530300093015","article-title":"The Role of Hypotension in Septic Encephalopathy Following Surgical Procedures","volume":"49","author":"Wijdicks","year":"1992","journal-title":"Arch. Neurol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S2213-2600(14)70246-2","article-title":"Cognitive decline after sepsis","volume":"3","author":"Annane","year":"2015","journal-title":"Lancet Respir. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"538.e7","DOI":"10.1016\/j.jcrc.2010.05.004","article-title":"Brain Autopsy Findings in ICU Patients Previously Suffering from Delirium: A Pilot Study","volume":"25","author":"Janz","year":"2010","journal-title":"J. Crit. Care"},{"key":"ref_36","first-page":"137","article-title":"Prophylaxis of dexamethasone protects patients from further post-operative delirium after cardiac surgery: A randomized trial","volume":"18","author":"Mardani","year":"2013","journal-title":"J. Res. Med. Sci. Off. J. Isfahan Univ. Med. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"485","DOI":"10.5414\/CP204791","article-title":"Treatment of delirium in intensive care patients with sepsis using daily intravenous infusions with omega-3 fatty acids","volume":"63","author":"Wang","year":"2025","journal-title":"Int. J. Clin. Pharmacol. Ther."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1124\/pr.117.014092","article-title":"Anti-Inflammatory Effects of Omega-3 Fatty Acids in the Brain: Physiological Mechanisms and Relevance to Pharmacology","volume":"70","author":"Nadjar","year":"2018","journal-title":"Pharmacol. Rev."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"77","DOI":"10.4103\/2008-7802.182734","article-title":"Effects of Omega-3 Supplement in the Treatment of Patients with Bipolar I Disorder","volume":"7","author":"Alikhani","year":"2016","journal-title":"Int. J. Prev. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s11064-023-04020-9","article-title":"Fish oil omega-3 Fatty Acids Alleviate Postoperative delirium-like Behavior in aged mice by Attenuating Neuroinflammation and Oxidative Stress","volume":"49","author":"Zhu","year":"2024","journal-title":"Neurochem. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e370","DOI":"10.1016\/j.bja.2022.05.025","article-title":"Protective effects of omega-3 fatty acids in a blood-brain barrier-on-chip model and on postoperative delirium-like behaviour in mice","volume":"130","author":"Yang","year":"2023","journal-title":"Br. J. Anaesth."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1111\/j.1399-6576.2008.01860.x","article-title":"Gastrointestinal symptoms in intensive care patients","volume":"53","author":"Reintam","year":"2009","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1177\/0148607114526450","article-title":"Prevalence, risk factors, clinical consequences, and treatment of enteral feed intolerance during critical illness","volume":"39","author":"Gungabissoon","year":"2015","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1111\/aas.12302","article-title":"Definition, prevalence, and outcome of feeding intolerance in intensive care: A systematic review and meta-analysis","volume":"58","author":"Blaser","year":"2014","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1097\/00003246-200110000-00018","article-title":"Upper digestive intolerance during enteral nutrition in critically ill patients: Frequency, risk factors, and complications","volume":"29","author":"Mentec","year":"2001","journal-title":"Crit. Care Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"655.e7","DOI":"10.1016\/j.jcrc.2014.12.019","article-title":"Prokinetic drugs for gastric emptying in critically ill ventilated patients: Analysis through breath testing","volume":"30","author":"Hersch","year":"2015","journal-title":"J. Crit. Care"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"102066","DOI":"10.1016\/j.gassur.2025.102066","article-title":"Effects of perioperative \u03c9-3 fish oil fat emulsion on postoperative gastric emptying function following Roux-en-Y reconstruction for gastric cancer","volume":"29","author":"Jing","year":"2025","journal-title":"J. Gastrointest. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e895","DOI":"10.1002\/ctm2.895","article-title":"Immunomodulation by intravenous omega-3 fatty acid treatment in older subjects hospitalized for COVID-19: A single-blind randomized controlled trial","volume":"12","author":"Arnardottir","year":"2022","journal-title":"Clin. Transl. Med."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Berlana, D., Albertos, R., Barquin, R., Pau-Parra, A., D\u00edez-Poch, M., L\u00f3pez-Mart\u00ednez, R., Cea, C., Cantenys-Molina, S., and Ferrer-Costa, R. (2024). Impact of Omega-3 Fatty Acid Supplementation in Parenteral Nutrition on Inflammatory Markers and Clinical Outcomes in Critically Ill COVID-19 Patients: A Randomized Controlled Trial. Nutrients, 16.","DOI":"10.3390\/nu16183046"},{"key":"ref_50","first-page":"308","article-title":"Efficacy of omega-3 fatty acids for hospitalized COVID-19 patients: A systematic review and meta-analysis of randomized controlled trials","volume":"32","author":"Yue","year":"2023","journal-title":"Asia Pac. J. Clin. Nutr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/6\/939\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T10:29:48Z","timestamp":1773743388000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/6\/939"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,17]]},"references-count":50,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["nu18060939"],"URL":"https:\/\/doi.org\/10.3390\/nu18060939","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,17]]}}}