title: Practicalities of selenium supplementation in critically ill patients.
abstract: OBJECTIVE
  To review the reason for and clinical effects of selenium supplementation in critically ill patients.
  
  
  RESULTS
  Selenium-dependent enzymes and selenoprotein P regulate immune and endothelial cell function. Obviously not the anorganic compounds of selenium but the activity of selenium-dependent enzymes is the most important factor modulating the immune system and the clinical outcome of patients. Despite low selenium levels in severely ill patients and low glutathione peroxidase activity associated with the extent of multiorgan dysfunction, only a few trials have investigated the effect of selenium supplementation on clinical outcome. A metaanalysis did not reveal a statistically significant survival rate with selenium supplementation, but suggested a dose-dependent trend. The recently completed multicentre trial on high-dose selenium supplementation in septic patients also did not reveal a significant overall reduction in mortality.
  
  
  CONCLUSIONS
  The available evidence suggests that selenoproteins play an important role in the immunomodulation of critically ill patients and a sodium selenite supplementation upregulates these selenoenzymes. The intervention trials with sodium selenite performed to date are small and therefore only a tendency in reduction of morbidity and mortality could be demonstrated. Larger trials are necessary to show the supposed benefits and risks of selenite supplementation in critically ill patients.
authors.affiliation: Intensive Care Unit, Medizinische Klinik, Munich, Germany.
authors.forename: Matthias Wa
authors.initials: MW
authors.lastname: Angstwurm
authors.forename: Roland
authors.initials: R
authors.lastname: Gaertner
mesh_terms: D000975:Antioxidants / Q000378:metabolism / Q000627:therapeutic use*; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D004306:Dose-Response Relationship, Immunologic; D006801:Humans; D012643:Selenium / Q000378:metabolism* / Q000627:therapeutic use*; D051149:Selenoprotein P / Q000276:immunology / Q000378:metabolism / Q000502:physiology; D051140:Selenoproteins / Q000276:immunology* / Q000378:metabolism / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D000975:Antioxidants; D051149:Selenoprotein P; D051140:Selenoproteins; D012643:Selenium