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Selenium supplementation for critically ill adults.

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Selenium and ebselen supplementation in critically ill patients showed a potential reduction in mortality, but evidence quality is very low. Further high-quality trials are needed to confirm benefits and address methodological inadequacies.

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Area of Science:

  • Critical care medicine
  • Nutritional science
  • Pharmacology

Background:

  • Selenium is an essential trace mineral vital for immune function, tissue defense, and thyroid health.
  • Optimizing selenium status may mitigate tissue damage and infection in critically ill adults.
  • This review is an update of a Cochrane review originally published in 2004.

Purpose of the Study:

  • To evaluate the impact of selenium or ebselen supplementation on mortality in critically ill patients.
  • To assess the effects of supplementation on infection rates, mechanical ventilation duration, and ICU/hospital length of stay.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs).
  • Searched multiple databases including Cochrane Library, MEDLINE, and EMBASE up to May 2014.
  • Included 16 RCTs with 2084 participants; data extracted independently by two reviewers.

Main Results:

  • Thirteen trials of intravenous sodium selenite suggested a significant mortality reduction (RR 0.82, 95% CI 0.72 to 0.93), but with very low evidence quality and high risk of bias.
  • Meta-analysis of ebselen trials showed no significant mortality benefit (RR 0.83, 95% CI 0.52 to 1.34).
  • No significant effects observed for selenium or ebselen on infection rates, ventilation duration, or length of stay; results must be interpreted cautiously due to trial limitations.

Conclusions:

  • Current evidence for recommending selenium or ebselen supplementation in critically ill patients is disputed.
  • High-quality trials are needed to address methodological shortcomings, including sample size and study design.
  • Further research is required to definitively establish the efficacy and safety of these supplements in critical care settings.