High-dose selenium reduces ventilator-associated pneumonia and illness severity in critically ill patients with systemic inflammation

Manzanares, William; Biestro, Alberto; Torre, Marı́a H.; Galusso, Federico; Facchin, Gianella; Hardy, Gil

doi:10.1007/s00134-011-2212-6

Cited by 100 publications

(105 citation statements)

References 36 publications

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“…There are studies performed with selenium in infectious complications in critically ill patients (56,57). In a study, high-dose selenium treatment was shown to reduce the incidence of ventilator-associated pneumonia (56).…”

Section: Antioxidantsmentioning

confidence: 99%

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Malnutrition in Intensive Care Units: An Important Risk Factor for Intensive Care Unit-Acquired Infections

Gündoğan

Bayram²,

Alp

2015

Yoğun Bakim Derg

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Intensive care units have the highest prevalence of nosocomial infections in hospitals. Good nutritional support is essential to prevent nosocomial infections. However, malnutrition is a common and important problem in intensive care units, especially in developing countries. For the prevention of malnutrition, a team approach is needed. Immunonutrition is nutrition that affects the immune response in various ways and increases the strength of the immune system. Pharmaconutrition is the administration of immunonutrients over the daily recommended doses that act like pharmacological agents and drugs. The major immunonutrients are glutamine, arginine, omega-3 fatty acids, nucleotides, antioxidants (selenium, vitamin E, vitamin C, zinc, copper, and Nacetyl cysteine), probiotics, prebiotics, and synbiotics. The aim of this review is to highlight the pathophysiology and role of malnutrition in intensive care unit-acquired infections (ICU-AIs) and the use of immunonutrients to prevent ICU-AIs. (Yoğun Bakım Derg 2014; 5: 36-42)

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Section: Antioxidantsmentioning

confidence: 99%

“…In a study, high-dose selenium treatment was shown to reduce the incidence of ventilator-associated pneumonia (56). In the study by Andrews et al in critically ill patients, adding selenium to parenteral nutritional solutions was reported to reduce the development of new infections (57).…”

Section: Antioxidantsmentioning

confidence: 99%

Malnutrition in Intensive Care Units: An Important Risk Factor for Intensive Care Unit-Acquired Infections

Gündoğan

Bayram²,

Alp

2015

Yoğun Bakim Derg

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“…In certain patient populations, reduced plasma selenium levels have been associated with increased morbidity and mortality, 13,128,174 therefore it may be prudent to further assess plasma selenium levels in transfusion-dependent and massively transfused patients and if indicated, to consider supplementation.…”

Section: Discussionmentioning

confidence: 99%

“…Studies in the critically ill suggest that selenium should be administered prior to injury, as giving it after injury seems to have little effect on oxidative injury. 128 Given that the onset of injury in cardiac surgical patients is predictable (initiation of CPB plus removal of aortic cross clamp) the cardiac surgical patient may be the ideal patient to benefit from selenium supplementation. However, to understand which patients may potentially benefit from supplementation it is first important to know (i) background levels in the local healthy population, (ii) what are the clinical consequences of low selenium levels.…”

Section: Intra-operative Influencesmentioning

confidence: 99%

“…Their activity is dependent on appropriate levels of essential trace elements such as selenium for GPx activity, 183 and copper and zinc for SOD activity. 184,185 Reductions of selenium in non-cardiac critically ill patients have been associated with increases in mortality and morbidity, 5,128 while a recent study of adult cardiac surgical patients indicated that decreases in selenium were associated with increased postoperative multi-organ failure (MOF). 13 Hence, understanding the etiology of trace element reductions and their influence on oxidative stress during cardiac surgery may inform improvements to CPB circuits, and identify ways to reduce morbidities.…”

Section: Introductionmentioning

confidence: 99%

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Selenium and oxidative stress modulation during extracorporeal circulation

McDonald¹

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Oxidative stress occurs when there is an imbalance between reactive oxygen and nitrogen species (RNOS) and the antioxidant system. In cardiac surgery patients and the critically ill there is an association between oxidative stress and morbidity and mortality.Extracorporeal circulation (ECC) encompasses cardiopulmonary bypass (CPB) which is used for cardiac surgery; extracorporeal membrane oxygenation (ECMO) which is used for cardio-respiratory support in the critically ill and haemodialysis which is used in patients with intermittent or end-stage renal failure.During ECC, the patient's total blood volume is in direct contact with an artificial surface for extended periods. In addition, there is often pre-existing inflammation, surgical trauma and/or ischemia-reperfusion (I-R) injury, all of which are major activators for the increased production of RNOS. Concurrent decreases in the level of essential antioxidants and trace elements (such as selenium, zinc and copper) occur, which upset redox balance in favour of oxidative stress. The trace element selenium is required for the normal function of the antioxidant enzyme glutathione peroxidase (GPx). Despite in vitro and biochemical data suggesting that reinforcement of antioxidant activity by selenium supplementation might reduce excessive oxidative stress damage, there is conflicting evidence in clinical studies.The reason for failure of antioxidant supplementation in the clinical setting is currently unclear.We postulated that the ECC and its associated interventions such as transfusion, might have a larger impact on trace element loss, antioxidant function and the oxidative stress response than previously recognised. This led to the following questions:  What is the selenium level in healthy Queensland residents, and is this level similar to that reported in other parts of the world? Does a patient's pre-CPB or pre-ECMO circulating selenium level influence their outcome? Does the ECC independently alter circulating selenium levels and the oxidative stress response? Do other interventions during ECC, such as transfusion, alter circulating selenium and oxidative stress levels?iii This thesis focussed on oxidative stress and the trace element selenium, because oxidative stress is associated with poorer outcomes in cardiac and critically ill patients, and decreased selenium is independently associated with poorer outcomes. To answer the research questions outlined above, a series of experiments were designed and conducted, and they generated the following new information.The average selenium level in a Queensland blood donor population was defined at 1.09 µmol/L (Chapter 3). In addition 88.5% of participants had a selenium level lower than the critical level required for maximal glutathione peroxidase activity, which has previously been determined to be between 1.14 -1.27 µmol/L. Furthermore, this study generated novel information that packed red blood cells and buffy coat pooled platelets have very low levels of selenium (≤ 0.3 µmol/L).The effect of car...

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Effect of Sodium Selenite Administration and Procalcitonin-Guided Therapy on Mortality in Patients With Severe Sepsis or Septic Shock

et al. 2016

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High-dose selenium reduces ventilator-associated pneumonia and illness severity in critically ill patients with systemic inflammation

Cited by 100 publications

References 36 publications

Malnutrition in Intensive Care Units: An Important Risk Factor for Intensive Care Unit-Acquired Infections

Malnutrition in Intensive Care Units: An Important Risk Factor for Intensive Care Unit-Acquired Infections

Selenium and oxidative stress modulation during extracorporeal circulation

Effect of Sodium Selenite Administration and Procalcitonin-Guided Therapy on Mortality in Patients With Severe Sepsis or Septic Shock

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