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Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients.
BMJ. 2011 Mar 17; 342:d1542.BMJ

Abstract

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 (Sepsis-related 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 ISRCTN87144826.

Authors+Show Affiliations

Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH4 2XU, UK. p.andrews@ed.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21415104

Citation

Andrews, Peter J D., et al. "Randomised Trial of Glutamine, Selenium, or Both, to Supplement Parenteral Nutrition for Critically Ill Patients." BMJ (Clinical Research Ed.), vol. 342, 2011, pp. d1542.
Andrews PJ, Avenell A, Noble DW, et al. Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients. BMJ. 2011;342:d1542.
Andrews, P. J., Avenell, A., Noble, D. W., Campbell, M. K., Croal, B. L., Simpson, W. G., Vale, L. D., Battison, C. G., Jenkinson, D. J., & Cook, J. A. (2011). Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients. BMJ (Clinical Research Ed.), 342, d1542. https://doi.org/10.1136/bmj.d1542
Andrews PJ, et al. Randomised Trial of Glutamine, Selenium, or Both, to Supplement Parenteral Nutrition for Critically Ill Patients. BMJ. 2011 Mar 17;342:d1542. PubMed PMID: 21415104.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients. AU - Andrews,Peter J D, AU - Avenell,Alison, AU - Noble,David W, AU - Campbell,Marion K, AU - Croal,Bernard L, AU - Simpson,William G, AU - Vale,Luke D, AU - Battison,Claire G, AU - Jenkinson,David J, AU - Cook,Jonathan A, AU - ,, Y1 - 2011/03/17/ PY - 2011/3/19/entrez PY - 2011/3/19/pubmed PY - 2011/5/10/medline SP - d1542 EP - d1542 JF - BMJ (Clinical research ed.) JO - BMJ VL - 342 N2 - 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 (Sepsis-related 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 ISRCTN87144826. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/21415104/Randomised_trial_of_glutamine_selenium_or_both_to_supplement_parenteral_nutrition_for_critically_ill_patients_ L2 - https://www.bmj.com/lookup/pmidlookup?view=long&pmid=21415104 DB - PRIME DP - Unbound Medicine ER -