Pharmaconutrition with selenium in critically ill patients: what do we know?

Area of Science:

• Biochemistry
• Clinical Nutrition
• Critical Care Medicine

Background:

• Selenium is vital for selenoproteins, offering antioxidant, anti-inflammatory, and immune benefits.
• Reduced selenium and glutathione peroxidase activity (GPx) are linked to severe illness (SIRS, MOD, MOF) and poor outcomes.
• Previous studies and meta-analyses showed mixed results for selenium therapy in critically ill patients.

Purpose of the Study:

• To review the current evidence on selenium's role in critical illness.
• To examine the conflicting results from major clinical trials like REDOXS and MetaPlus.
• To highlight the need for more research on intravenous selenium pharmacokinetics, especially in patients with multiorgan dysfunction and renal impairment.

Main Methods:

• Review of existing randomized clinical trials (RCTs) and meta-analyses.
• Analysis of findings from large pharmaconutrition studies (REDOXS, MetaPlus).
• Discussion of proposed intravenous selenium dosing strategies.

Main Results:

• Selenium therapy benefits in critically ill patients remain controversial.
• Large trials (REDOXS, MetaPlus) yielded conflicting or negative results, with potential harm in renal dysfunction.
• The efficacy of selenium likely depends on dose, administration route, and patient population.

Conclusions:

• Optimal intravenous selenium dosing and efficacy in Systemic Inflammatory Response Syndrome (SIRS) and multiorgan dysfunction (MOD) require further investigation.
• More pharmacokinetic data is needed, particularly for patients with renal dysfunction.
• Current evidence does not definitively establish selenium's optimal use in critical care.