Selenium supplementation for critically ill adults

Avenell, Alison; Noble, David W.; Barr, Jason; Engelhardt, Thomas

doi:10.1002/14651858.cd003703.pub2

Cited by 44 publications

(30 citation statements)

References 34 publications

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“…In 2009, guidelines for nutritional support recommended that a combination of antioxidant vitamins and trace minerals (specifically including Se) should be provided to all critically ill patients receiving specialized nutritional therapy [25,26]. Several studies in patients with trauma and burns exploring the effect of a ''cocktail'' of micronutrients (Zn, Cu, Se, vitamins E and C) have indicated a decrease in the frequency of MOF and infectious complications [27,28]. Na-selenite has been used most frequently in recent and currently ongoing studies, despite its potential toxicity.…”

Section: Discussionmentioning

confidence: 99%

High-dose selenium substitution in sepsis: a prospective randomized clinical trial

et al. 2011

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Section: Discussionmentioning

confidence: 99%

High-dose selenium substitution in sepsis: a prospective randomized clinical trial

et al. 2011

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“…Participants had a mean (SD) age of 63.8 (14.9) years, 39% were women, 89% required level 3 care, 25% were medical patients (defined as non-surgical cause for admission), and the median APACHE II score was 20 (interquartile range [16][17][18][19][20][21][22][23][24][25]. At randomisation, 89% were already receiving antibiotics, and 27% were undernourished.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients

Andrews

Avenell²,

Noble³

et al. 2011

BMJ

313

178

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Objective To determine whether inclusion of glutamine, selenium, or both in a standard isonitrogenous, isocaloric preparation of parenteral nutrition influenced new infections and mortality among critically ill patients. Design Randomised, double blinded, factorial, controlled trial. Setting Level 2 and 3 (or combined) critical care units in Scotland. All 22 units were invited, and 10 participated. Participants 502 adults in intensive care units and high dependency units for ≥48 hours, with gastrointestinal failure and requiring parenteral nutrition. Interventions Parenteral glutamine (20.2 g/day) or selenium (500 μg/day), or both, for up to seven days. Main outcome measures Primary outcomes were participants with new infections in the first 14 days and mortality. An intention to treat analysis and a prespecified analysis of patients who received ≥5 days of the trial intervention are presented. Secondary outcomes included critical care unit and acute hospital lengths of stay, days of antibiotic use, and modified SOFA (Sepsisrelated Organ Failure Assessment) score. Results Selenium supplementation did not significantly affect patients developing a new infection (126/251 v 139/251, odds ratio 0.81 (95% CI 0.57 to 1.15)), except for those who had received ≥5 days of supplementation (odds ratio 0.53 (0.30 to 0.93)). There was no overall effect of glutamine on new infections (134/250 v 131/ 252, odds ratio 1.07 (0.75 to 1.53)), even if patients received ≥5 days of supplementation (odds ratio 0.99 (0.56 to 1.75)). Six month mortality was not significantly different for selenium (107/251 v 114/251, odds ratio 0.89 (0.62 to 1.29)) or glutamine (115/250 v 106/252, 1.18 (0.82 to 1.70)). Length of stay, days of antibiotic use, and modified SOFA score were not significantly affected by selenium or glutamine supplementation. Conclusions The primary (intention to treat) analysis showed no effect on new infections or on mortality when parenteral nutrition was supplemented with glutamine or selenium. Patients who received parenteral nutrition supplemented with selenium for ≥5 days did show a reduction in new infections. This finding requires confirmation. Trial registration Current Controlled Trials ISRCTN87144826INTRODUCTION Infection and sepsis are major causes of increased mortality, morbidity, and resource use in intensive care units. They are associated with both illness and drug related impairment of the immune system, compounded by malnutrition often observed in patients admitted to critical care. 1The enteral feeding route is preferred for critically ill patients because of its reduced costs and risk of infective complications.2 Parenteral nutrition, however, has an important role because many intensive care patients have gastrointestinal dysfunction. 3Recent systematic reviews have suggested that parenteral administration of glutamine to critically ill patients reduces mortality (risk ratio 0.71 (95% confidence interval 0.55 to 0.92)) and new infections (risk ratio 0.76 (0.62 to 0.93)). 4 Selenium supplementati...

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“…110 The Cochrane Database Systematic Review by Avenell et al (updated 2007) investigating the effects of single-nutrient supplementation, specifically selenium supplementation, including the selenium-containing compound ebselen, concluded: "There is limited evidence to recommend supplementation of critically ill patients with selenium or ebselen". 111 They found no significant differences for overall mortality and infectious complications and no clear evidence of the benefits of such supplementation for ventilator days, LICU, length of stay or quality of life. However, they did find that the evidence was more suggestive of a benefit on mortality in the first month for general ICU patients when compared with those with severe pancreatitis (p-value = 0.02).…”

Section: Cccpg Aspen/sccm Espenmentioning

confidence: 93%

“…When the SIGNET trial data 58 for selenium supplementation were entered into the current Cochrane systematic review, 111 the random effects risk ratio for mortality changed from 0.75 (0.59-0.96, I 2 = 0%) to 0.86 (0.74-1, I 2 = 0%), and the risk ratio for new infections changed from 1.22 (0.67-2.23, I 2 = 0%) to 0.93 (0.79-1.09, I 2 = 0%). 111 In one older study, high-dose vitamin C administration during resuscitation (66 mg/kg/hour) was shown to attenuate lipid peroxidation and reduce resuscitation fluid requirements, as well as post-burn oedema. The length of mechanical ventilation was also significantly reduced and improved early respiratory function was observed.…”

Section: Cccpg Aspen/sccm Espenmentioning

confidence: 99%