This article is an abstract from information on OXEPA from Abbot Laboratories’ online website, http://www.ross.com To view the entire article select Our Products, then OXEPA, nutrient information.

Usage

OXEPA is a low-carbohydrate, calorically dense enteral nutrition product designed for the dietary management of critically ill patients on mechanical ventilation. It contains eicosapentaenoic acid (EPA) (from sardine oil), gamma-linolenic acid (GLA) (from borage oil), and antioxidants. OXEPA can be used as a sole source of nutrition for tube feeding.

  • For critically ill patients on mechanical ventilation
  • For critically ill patients with LUNG INJURY, such as: pneumonia; sepsis; chest injury; multiple trauma; burns; shock and hypoperfusion; aspiration or near-drowning; cardiopulmonary bypass; or hyperfusion-associated lung injury.


Features

  • Complete, balanced nutrition for tube-feeding patients
  • Unique patented oil blend-contains EPA from sardine oil and GLA from borage oil
  • Contains 25% of fat as MCTs for improved fat absorption
  • Fortified with elevated levels of the antioxidants all-natural vitamin E, beta-carotene, and vitamin C
  • 1.5 Cal/mL, 355 Cal/8 fl oz, and a moderate osmolality of 493 mosm/kg H20
  • Caloric density is high to minimize the volume required to meet energy needs
  • Meets 100% of RDI for 24 key vitamins and minerals in 1420 Calories (four 8-fl-oz cans)
  • Lactose- and gluten-free


Clinical Research
Clinical research using various models of sepsis-induced ARDS has shown that nutritional intervention with a diet (OXEPA) containing eicosapentaenoic acid (EPA) from fish oil, gamma-linolenic acid (GLA) from borage oil, and elevated levels of antioxidants: Improved cardiopulmonary hemodynamics and respiratory gas exchange26 Reduced the severity of pulmonary microvascular protein permeability27 Reduced pulmonary neutrophil recruitment28 Reduced the synthesis of proinflammatory eicosanoids of lung injury26-28 Rapidly displaced arachidonic acid from lung and alveolar macrophage phospholipids29,30 Maintained alveolar macrophage functions, including respiratory burst, bactericidal, and phagocytosis31,32

Based on those preclinical findings, a prospective, randomized, double-blinded, controlled, multicenter clinical trial33-36 was conducted to determine whether early continuous enteral feeding of OXEPA to patients with acute lung injury (ALI)/ARDS could: Improve oxygenation Decrease the requirements for ventilatory support Decrease the length of stay in the intensive care unit compared to a standard low-carbohydrate diet

The study was conducted in the intensive care units of five academic teaching hospitals in the United States. One hundred forty-six (146) patients with ARDS (as defined by the American-European Consensus Conference) caused by sepsis/pneumonia, trauma, or aspiration injury were enrolled in the study. Patients meeting entry criteria were randomized and continuously tube-fed either OXEPA or an isonitrogenous, isocaloric standard diet at a minimum caloric delivery of 75% of basal energy expenditure x 1.3 for at least 4 to 7 days.

These beneficial effects of OXEPA on pulmonary neutrophil recruitment, gas exchange, requirement for mechanical ventilation, length of intensive care unit stay, and the incidence of new organ failures suggest that this enteral formula would be a useful adjuvant therapy in the clinical management of patients with or at risk of developing ARDS.

26. Murray MJ, Kumar M, Gregory TJ, et al: Select dietary fatty acids attenuate cardiopulmonary dysfunction during acute lung injury in pigs. Am J Physiol 1995;269:H2090-H2099.

27. Mancuso P, Whelan J, DeMichele SJ, et al: Effects of eicosapentaenoic and g-linolenic acid on lung permeability and alveolar macrophage eicosanoid synthesis in endotoxic rats. Crit Care Med 1997;25:523-532.

28. Mancuso P, Whelan J, DeMichele SJ, et al: Dietary fish oil and fish and borage oil suppress intrapulmonary proinflammatory eicosanoid biosynthesis and attentuate pulmonary neutrophil accumulation in endotoxic rats. Crit Care Med 1997;25:1198-1206.

29. Palombo JD, DeMichele SJ, Lydon EE, et al: Rapid modulation of lung and liver macrophage phospholipid fatty acids in endotoxemic rats by continuous enteral feeding with n-3 and g-linolenic fatty acids. Am J Clin Nutr 1996;63:208-219.

30. Palombo JD, DeMichele SJ, Lydon E, Bistrian BR: Cyclic vs continuous enteral feeding with w-3 and g-linolenic fatty acids: Effects on modulation of phospholipid fatty acids in rat lung and liver immune cells. JPEN 1997;21:123-132.

31. Palombo JD, DeMichele SJ, Boyce P, et al: Alveolar macrophages (AM) maintain respiratory burst and bactericidal function after dietary displacement of phospholipid arachidonic acid (AA) in vivo. JPEN 1998;22(1):S4.

32. Palombo JD, DeMichele SJ, Boyce PJ, et al: Effect of short-term enteral feeding with eicosapentaenoic and gamma-linolenic acids on alveolar macrophage eicosanoid synthesis and bactericidal function in rats. Crit Care Med 1999;27(9):1908-1915.

33. Gadek JM, DeMichele SJ, Karlstad MD, et al: Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid and antioxidants in patients with acute respiratory distress syndrome. Crit Care Med 1999;27(8):1409-1420.

34. Gadek J, DeMichele S, Karlstad M, et al: Enteral nutrition with eicosapentaenoic acid (EPA), gamma-linolenic acid (GLA), and antioxidants reduces pulmonary inflammation and new organ failures in patients with acute respiratory distress syndrome (ARDS). Chest 1998;114(4):277S.

35. Pacht E, Nelson J, DeMichele S, et al: Specialized enteral nutrition decreases lung permeability and improves oxygenation in patients with acute respiratory distress syndrome (ARDS). Am J Resp Crit Care Med 1999;159(3):A694.

36. Gadek J, DeMichele S, Nelson J, et al: Specialized enteral nutrition, Oxepa, suppresses intrapulmonary inflammatory mediators in patients with acute respiratory distress syndrome (ARDS). Crit Care Med 1999;27(12):A125.