Selenium supplementation for critically ill adults.

Systematic review and meta-analysis of randomized trials in critically ill adults receiving ICU care. Included populations covered sepsis/SIRS, trauma, pancreatitis, burns, and acute neurological injury; neonates and participants younger than 18 years were excluded.

Across the included trials, selenium was usually given as intravenous sodium selenite, with regimens ranging from 500 mcg/day to a 4000 mcg loading dose followed by 300 to 1000 mcg/day for 3 to 28 days. Ebselen was given orally at 150 mg twice daily for 14 days. Some selenium trials also used parenteral nutrition as part of supportive care, and one trial tested selenium plus glutamine.

There is no clear evidence that selenium or ebselen supplementation reduces mortality in critically ill adults. A pooled 28-day analysis suggested a possible mortality reduction, RR 0.84 (0.69 to 1.02), but the 90-day estimate was RR 0.96 (0.78 to 1.18), and the apparent benefit was largely driven by trials at high risk of bias. There were no clear benefits for infections, days on mechanical ventilation, ICU length of stay, or hospital length of stay. Overall confidence in the evidence was very low.

The evidence base was small and methodologically weak, with many trials at high risk of bias and very low certainty overall. Trial populations, selenium regimens, and outcome reporting were heterogeneous, and several outcomes were sparsely or inconsistently reported. These limitations reduce confidence that the pooled mortality signal reflects a true treatment effect.