Selenium supplementation for critically ill adults

  • Review
  • Intervention

Authors


Abstract

Background

Selenium is a trace mineral essential to health and has an important role in immunity, defence against tissue damage and thyroid function. Improving selenium status could help protect against overwhelming tissue damage and infection in critically ill adults.

Objectives

This review assessed the effects of selenium supplementation, including the selenium-containing compound ebselen, on adults recovering from critical illness.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 3), MEDLINE, EMBASE, CAB NAR, BIOSIS, CINAHL, Current Controlled Trials and reference lists. We contacted investigators and handsearched four journals. The date of the most recent search was August 2007.

Selection criteria

Randomized trials of selenium or ebselen supplementation by any route in adults with critical illness (including patients with burns, head injury, brain haemorrhage, cerebrovascular accident) and after surgery.

Data collection and analysis

Two authors independently extracted data and assessed trial quality. We sought additional information as required from trialists. We undertook pooling of data for outcomes and selected exploratory analyses were undertaken.

Main results

Ten randomized trials involving 1172 participants were included. The quality of trials, as reported, was poor, particularly for allocation concealment. The availability of outcome data was limited and trials involving selenium supplementation were mostly small. Thus the results must be interpreted with caution.

Seven trials of intravenous sodium selenite showed no statistically significant difference in mortality (relative risk (RR) 0.75, 95% confidence interval (CI) 0.53 to 1.06). In general intensive care patients the RR for selenium supplementation was 0.75 (95% CI 0.59 to 0.96). Three trials of ebselen showed no statistically significant difference in mortality (RR 0.83, 95% CI 0.51 to 1.35).

Three trials of intravenous sodium selenite found no statistically significant difference between groups for participants developing infection (RR 1.22, 95% CI 0.67 to 2.23). Three trials of ebselen provided data for participants developing infections (pyrexia, respiratory infections or meningitis), which were not statistically significant (RR 0.60, 95% CI 0.36 to 1.02).

No clear evidence emerged for the benefits of selenium or ebselen supplementation for the outcomes of days on a ventilator, length of intensive care unit stay, length of hospital stay or quality of life.

Authors' conclusions

There is limited evidence to recommend supplementation of critically ill patients with selenium or ebselen. Trials are required which overcome the defects of the reviewed studies, particularly inadequate size and methodology.

摘要

背景

硒的補充對病危成年病患的預後影響

硒是為人體健康中必需的微量元素。在免疫反應,抵禦組織損傷及甲狀腺功能中佔重要得角色。 在病危的成年患者身上,提高硒的狀態,可以幫助對抗十分嚴重的組織損傷和感染。

目標

此篇評估,硒的補充,包括硒化合物ebselen,對成年病危病人從病危狀態中復元的影響。

搜尋策略

我們搜尋了Cochrane Central Register of Controlled Trials(CENTRAL)(考科藍醫學資料庫,第3期, 2007年)MEDLINE, EMBASE,CAB NAR, BIOSIS, CINAHL, Current Controlled Trials 及其參考資料清單。我們和審查者接觸並搜尋了四篇論文。最近日期搜索為2007年8月。

選擇標準

在成年病危病人(包括燒傷,顱腦損傷,腦出血,腦血管意外和手術)及手術後以任何途徑補充硒或ebselen的隨機對照臨床試驗。

資料收集與分析

2位作者獨立選取數據和評估臨床試驗的品質。我們搜查的補充資料要求從出於選取的文章。我們著手於試驗結果中匯集數據,和選定的探索性分析。

主要結論

10個隨機對照臨床試驗其中包括1172位參加者。根據報告指出,臨床試驗的品質,特別是缺乏分配的隱蔽性。提供數據的結果是有限的,而且臨床試驗所補充的硒為少量,因此結果結果必須審慎評估。另外7個臨床試驗,以靜脈注射亞硒酸鈉(sodium selenite)顯示,死亡率無統計上的意義(相對危險(RR)的0.75,95 %的信賴區間(CI)的0.53至1.06)。在一般密集照顧病人補充硒的RR為是0.75 (95 % CI為0.59至0.96)。另有3個臨床試驗指出,補充ebselen的病人死亡率並無統計上的意義差異(RR為1.22,95 % CI為0.67至2.23)。另有3個臨床試驗,在進展中的感染症病患(病患有發燒,呼吸道感染,或是腦膜炎)給予ebselen,在統計上病人顯著的差異(RR 為0.60, 95% CI為0.36至1.02)。沒有明確的證據指出補充硒或ebselen後,呼吸器使用時間,加護病房住院時間,住院時間或生活品質等方面有明顯的好處。

作者結論

關於在病危病人建議使用硒或ebselen證據薄弱。這些臨床試驗必須克服研究上的缺陷,特別是不足的樣本數和方法論。

翻譯人

本摘要由臺灣大學附設醫院賴佳欣翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

關於重症照護補充硒並無足夠的證據。硒是為人體健康中必需的微量元素。硒能幫助對抗感染和組織破壞及重症照護時的重要問題。回顧載重症照護病人給予硒或ebselen的臨床試驗,並無明確證據指出給予硒對病人有幫助或傷害。關於在重症病患給予硒補充是否有幫助,還需要的前提是包含良好設計且有力的隨機對照試驗。

Plain language summary

Selenium supplements for adults who are critically ill

Selenium is a mineral that is essential to health. It has an important role in defence against tissue damage and disease and improving selenium status could help protect adults with overwhelming illness. This review assessed the effects of selenium supplementation on adults recovering from critical illness.
Ten trials involving 1172 participants were included. The quality of trials, as reported, was poor. Outcome data were limited and these trials involving selenium supplementation were mostly small. Thus the results must be interpreted with caution.
Seven trials of intravenous sodium selenite showed no effect on mortality. Three trials of the selenium-containing compound ebselen also showed no effect on mortality. No effects on infections or adverse events were found.
No clear evidence emerged for the benefits of selenium or ebselen supplementation for days on a ventilator, length of intensive care unit stay, length of hospital stay or quality of life. There is, therefore, no clear evidence to recommend supplementation of critically ill patients with selenium or ebselen. Trials are required which overcome the defects of the reviewed studies, particularly inadequate size and methodology.

Ancillary