Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients
Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients
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DOI：
10.1136/bmj.d1542
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发表时间：
2011-03-17
影响因子：
105.7
通讯作者：
Cook, Jonathan A.
中科院分区：
文献类型：
--
作者：
Andrews, Peter J. D.;Avenell, Alison;Cook, Jonathan A.
目的为了确定是否包括谷氨酰胺，硒，或两者都在一个标准的等氮，等热量的肠外营养制剂的影响新的感染和死亡率之间的危重病patients.Design随机，双盲，析因，对照试验。设置2级和3级（或合并）重症监护病房在苏格兰。所有22个单位都被邀请，其中10个参与。参与者502名成年人在重症监护室和高依赖单位>= 48小时，胃肠道衰竭，需要肠外营养。（20.2克/天）或硒（500 μ g/天），或两者并用，最多7天。主要结果测量主要结果是参与者在最初14天内有新的感染和死亡率。提供了接受≥ 5天试验干预的患者的意向治疗分析和预先规定的分析。次要结局包括重症监护室和急性住院时间、抗生素使用天数和改良SOFA结果补充硒对患者发生新发感染没有显著影响（126/251 v139/251，比值比0.81（95%CI 0.57 - 1.15）），除了那些接受≥ 5天补充的人（比值比0.53（0.30 - 0.93））。谷氨酰胺对新感染没有总体影响（134/250 v 131/252，比值比1.07（0.75至1.53）），即使患者接受了>= 5天的补充（比值比0.99（0.56至1.75））。硒（107/251 vs 114/251，比值比0.89（0.62 - 1.29））或谷氨酰胺（115/250 vs 106/252，1.18（0.82 - 1.70））的6个月死亡率无显著差异。住院时间，天的抗生素使用，并修改SOFA评分没有显着影响硒或谷氨酰胺supply.Conclusions的主要（意向治疗）分析显示，新的感染或死亡率时，肠外营养补充谷氨酰胺或硒没有影响。接受补充硒的肠外营养>= 5天的患者确实显示出新发感染的减少。这一发现需要确认。
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 mu g/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.