title: Trace element supplementation after major burns modulates antioxidant status and clinical course by way of increased tissue trace element concentrations.
abstract: BACKGROUND
  After major burns, patients can develop nutritional deficiencies including trace element (TE) deficiencies. Various complications, such as infections and delayed wound healing, influence the clinical course of such patients.
  
  
  OBJECTIVE
  We aimed to investigate the effects of large, intravenous doses of TE supplements on circulating and cutaneous TE tissue concentrations, on antioxidant status, and on clinical outcome after major burns.
  
  
  METHODS
  This was a prospective, randomized, placebo-controlled trial in 21 patients aged 35 +/- 11 y (x +/- SD) with burns on 45 +/- 21% of their body surface area. Intravenous copper, selenium, and zinc (TE group) or vehicle (V group) was given with a saline solution for 14-21 d. Blood and urine samples were collected until day 20, and skin biopsy specimens were collected on days 3, 10, and 20.
  
  
  RESULTS
  The age of the patients and the severity of their burns did not differ significantly between the groups. Plasma TE concentrations were significantly higher in the TE group. In burned areas, skin contents of both selenium (P=0.05) and zinc (P=0.04) increased significantly by day 20. Plasma and tissue antioxidant status was improved by supplementation. The number of infections in the first 30 d was significantly lower in the TE group (P=0.015), with a median number of 2 versus 4 infections per patient in the TE and V groups, respectively, as a result of a reduction in pulmonary infections (P=0.03). Wound healing was improved in the TE group, with lower requirements for regrafting (P=0.02).
  
  
  CONCLUSIONS
  TE supplementation was associated with higher circulating plasma and skin tissue contents of selenium and zinc and improved antioxidant status. These changes were associated with improved clinical outcome, including fewer pulmonary infections and better wound healing.
authors.affiliation: Department of Adult Intensive Care Medicine & Burns Center, Lausanne, Switzerland. mette.berger@chuv.ch
authors.forename: Mette M
authors.initials: MM
authors.lastname: Berger
authors.forename: Malcolm
authors.initials: M
authors.lastname: Baines
authors.forename: Wassim
authors.initials: W
authors.lastname: Raffoul
authors.forename: Messod
authors.initials: M
authors.lastname: Benathan
authors.forename: René L
authors.initials: RL
authors.lastname: Chiolero
authors.forename: Chris
authors.initials: C
authors.lastname: Reeves
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Revelly
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Cayeux
authors.forename: Isabelle
authors.initials: I
authors.lastname: Sénéchaud
authors.forename: Alan
authors.initials: A
authors.lastname: Shenkin
mesh_terms: D000328:Adult; D000975:Antioxidants / Q000378:metabolism; D002056:Burns / Q000150:complications / Q000378:metabolism / Q000601:surgery / Q000628:therapy; D003300:Copper / Q000172:deficiency / Q000378:metabolism / Q000627:therapeutic use; D019587:Dietary Supplements; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D009751:Nutritional Requirements; D010084:Oxidation-Reduction; D011014:Pneumonia / Q000453:epidemiology* / Q000517:prevention & control; D011446:Prospective Studies; D012643:Selenium / Q000172:deficiency / Q000378:metabolism / Q000627:therapeutic use; D012867:Skin / Q000378:metabolism*; D016038:Skin Transplantation; D014131:Trace Elements / Q000172:deficiency / Q000378:metabolism / Q000627:therapeutic use; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects* / Q000502:physiology; D015032:Zinc / Q000172:deficiency / Q000378:metabolism / Q000627:therapeutic use
chemical_list: D000975:Antioxidants; D014131:Trace Elements; D003300:Copper; D012643:Selenium; D015032:Zinc