Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients

Study answer

What this study found

Primary outcomes were new infections within 14 days and mortality. In the intention-to-treat population, selenium did not significantly reduce new infections overall (126/251 vs 139/251; OR 0.81, 95% CI 0.57–1.15; P=0.24); glutamine did not reduce infections (134/250 vs 131/252; OR 1.07, 95% CI 0.75–1.53; P=0.71). No interaction between treatments. Six-month mortality showed no significant benefit for selenium (107/251 vs 114/251; OR 0.89, 95% CI 0.62–1.29) or for glutamine (115/250 vs 106/252; OR 1.18, 95% CI 0.82–1.70). In analyses restricted to those who received ≥5 days of trial PN,…

Study & population

Randomised, double-blind, factorial trial conducted in 10 Scottish critical care units; 502 adults (mean age 63.8 years; 39% women) in intensive care or high dependency units with gastrointestinal failure requiring parenteral nutrition for ≥48 hours; 89% level 3 care; 25% medical; median APACHE II score 20.

Intervention

Parenteral nutrition regimens delivered intravenously for up to seven days: four formulations: standard PN (12.5 g nitrogen, 2000 kcal); glutamine PN (12.5 g nitrogen including 20.2 g glutamine, 2000 kcal); standard PN plus selenium (500 μg/day); glutamine PN plus selenium (500 μg/day).

Key limitation

Limitations include: prespecified ITT analysis showed no overall benefit; observed infection reduction with selenium occurred only in a ≥5 days subgroup (risk of type I error in subgroup analyses); ventilator use data were not collected; start time for parenteral nutrition was not prespecified; center-to-center…

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Original abstract