Low serum selenium is associated with the severity of organ failure in critically ill children

s u m m a r yFollowing the new ESPEN Standard Operating Procedures, the previous guidelines to provide best medical nutritional therapy to critically ill patients have been updated. These guidelines define who are the patients at risk, how to assess nutritional status of an ICU patient, how to define the amount of energy to provide, the route to choose and how to adapt according to various clinical conditions. When to start and how to progress in the administration of adequate provision of nutrients is also described. The best determination of amount and nature of carbohydrates, fat and protein are suggested. Special attention is given to glutamine and omega-3 fatty acids. Particular conditions frequently observed in intensive care such as patients with dysphagia, frail patients, multiple trauma patients, abdominal surgery, sepsis, and obesity are discussed to guide the practitioner toward the best evidence based therapy. Monitoring of this nutritional therapy is discussed in a separate document.

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“…Selenium: Low serum Se is associated with intense inflammation, organ failures and poor outcome in children and adults [283].…”

Section: Commentarymentioning

confidence: 99%

ESPEN guideline on clinical nutrition in the intensive care unit

et al. 2019

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“…An examination of children enrolled in the CRISIS prevention trial also revealed that chronically ill children and those suffering from infection or sepsis are more likely to have depressed serum selenium levels [ 168 ]. Low serum selenium or an increased fraction of reduced GSHpx has also been associated with increased incidence of multi-organ failure in children admitted to the PICU [ 190 ]. Vice versa, an increase in serum selenium during critical illness has been associated with decreased ventilator dependence, ICU length of stay, and even mortality [ 191 ].…”

Section: Trace Elementsmentioning

confidence: 99%

Assessment of Micronutrient Status in Critically Ill Children: Challenges and Opportunities

et al. 2017

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Micronutrients refer to a group of organic vitamins and inorganic trace elements that serve many functions in metabolism. Assessment of micronutrient status in critically ill children is challenging due to many complicating factors, such as evolving metabolic demands, immature organ function, and varying methods of feeding that affect nutritional dietary intake. Determination of micronutrient status, especially in children, usually relies on a combination of biomarkers, with only a few having been established as a gold standard. Almost all micronutrients display a decrease in their serum levels in critically ill children, resulting in an increased risk of deficiency in this setting. While vitamin D deficiency is a well-known phenomenon in critical illness and can predict a higher need for intensive care, serum concentrations of many trace elements such as iron, zinc, and selenium decrease as a result of tissue redistribution in response to systemic inflammation. Despite a decrease in their levels, supplementation of micronutrients during times of severe illness has not demonstrated clear benefits in either survival advantage or reduction of adverse outcomes. For many micronutrients, the lack of large and randomized studies remains a major hindrance to critically evaluating their status and clinical significance.

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“…Major surgeries that control acute damages and induce acute-phase response may stimulate the immune system of the human body, thereby increasing inflamma-tory mediators and reactive oxygen species (ROS) (1,2). Although the presence of ROS is essential to the activation of the signaling pathways of antioxidant defense systems, their excessive production leads to multiple complications, such as delayed wound healing, and deterioration of the clinical condition (3,4).…”

Section: Introductionmentioning

confidence: 99%

“…Children undergoing major surgeries may experience metabolic and hormonal alterations, inflammation, and oxidative stress, which could lead to their admission to the intensive care unit (ICU) (2). The oxidative stress and inflammatory responses following surgical traumas may lead to insulin resistance, cell necrosis and apoptosis, immunosuppression, organ failure, and increased length of ICU and hospital stay (5).…”

Section: Introductionmentioning

confidence: 99%

Effects of High-Dose Selenium Supplementation on Oxidative Stress and Inflammatory Markers in Critically Ill Children After Gastrointestinal Surgery: A Randomized Clinical Trial

et al. 2020

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Background: Pediatric observational studies have indicated that most critically ill children have low serum selenium level, which is associated with the increased incidence of multiple organ failure and deteriorated clinical outcomes. Selenium plays a key role in the endogenous antioxidant defense mechanism and inflammatory pathways. Objectives: The present study aimed to assess the effects of high-dose selenium supplementation on the improvement of inflammatory and oxidative stress indices, as well as clinical outcomes, in pediatric patients with severe oxidative stress and inflammation following major gastrointestinal surgeries. Methods: This prospective, single-blind, randomized, parallel group superiority trial was conducted at the pediatric intensive care unit (PICU) of Akbar Pediatric Hospital in Mashhad, Iran in 2019. Patients were assigned to the supplementation (high-dose selenium: 20 µg/kg/d) and control groups (placebo with the recommended dietary allowance doses of selenium) using stratified blocks. Among 72 eligible critically ill children after gastrointestinal surgery, 66 patients completed the study. Inflammatory markers were measured and compared between the groups, including high-sensitivity C-reactive protein (hsCRP), interleukin 1 beta (IL-1β), prooxidant-antioxidant balance (PAB) assay, and clinical outcomes. Data analysis was performed in SPSS version 20 using the intention-to-treat approach. Results: Only 14 patients had optimal serum selenium concentrations before the surgery and PICU admission. At the end of the study, 90.6% of the patients (n = 29) in the intervention group and 100% (n = 34) of those in the placebo group had suboptimal serum selenium levels (< 50 ng/mL). Although supplementation with high-dose selenium decreased the inflammatory markers in the post-surgical critically ill children (-18 mg/mL and -37.5 pg/mL for hsCRP and IL-1β, respectively), the administered dose could not improve the serum glutathione peroxidase (GPx) concentrations as the selenium functional marker, as well as the PAB assay as the single test to assess the balance/imbalance of the oxidants and antioxidants simultaneously. Additionally, clinical outcomes such as infections, length of ICU stay, and 28-day mortality did not improve after the intervention. Conclusions: According to the results, high-dose selenium supplementation (20 µg/kg/d) in the post-surgical critically ill children could improve the serum inflammatory markers. However, the changes were suboptimal with no significant effects of the serum GPx concentrations, antioxidant defense system, and clinical outcomes.

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Low serum selenium is associated with the severity of organ failure in critically ill children

Cited by 21 publications

References 25 publications

ESPEN guideline on clinical nutrition in the intensive care unit

ESPEN guideline on clinical nutrition in the intensive care unit

Assessment of Micronutrient Status in Critically Ill Children: Challenges and Opportunities

Effects of High-Dose Selenium Supplementation on Oxidative Stress and Inflammatory Markers in Critically Ill Children After Gastrointestinal Surgery: A Randomized Clinical Trial

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