Pharmaconutrition With Selenium in Critically Ill Patients: What Do We Know?

摘要: Selenium is a component of selenoproteins with antioxidant, anti-inflammatory, and immunomodulatory properties. Systemic inflammatory response syndrome (SIRS), multiorgan dysfunction (MOD), failure (MOF) are associated an early reduction in plasma selenium glutathione peroxidase activity (GPx), both parameters correlate inversely the severity illness outcomes. Several randomized clinical trials (RCTs) evaluated therapy as monotherapy or antioxidant cocktails intensive care unit (ICU) patient populations, more recently several meta-analyses suggested benefits most seriously ill patients. However, largest RCT on pharmaconutrition glutamine antioxidants, REducing Deaths due to Oxidative Stress (REDOXS) Study, was unable find any improvement outcomes antioxidants provided by enteral parenteral route harm patients renal dysfunction. Subsequently, MetaPlus study demonstrated increased mortality medical when extra enterally. The treatment effect may be dependent dose, administration, whether administered other nutrients population studied. Currently, there few small studies evaluating pharmacokinetic profile intravenous (IV) SIRS, therefore data necessary, particularly MOD, including those According current knowledge, high-dose pentahydrate sodium selenite could given IV bolus injection (1000-2000 µg), which causes transient pro-oxidant, cytotoxic, anti-inflammatory effects, then followed continuous infusion 1000-1600 µg/d for up 10-14 days. Nonetheless, optimum dose efficacy still remain controversial need definitively established.