title: Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients.
abstract: 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.
  
  
  METHODS
  Randomised, double blinded, factorial, controlled trial.
  
  
  METHODS
  Level 2 and 3 (or combined) critical care units in Scotland. All 22 units were invited, and 10 participated.
  
  
  METHODS
  502 adults in intensive care units and high dependency units for ≥ 48 hours, with gastrointestinal failure and requiring parenteral nutrition.
  
  
  METHODS
  Parenteral glutamine (20.2 g/day) or selenium (500 μg/day), or both, for up to seven days.
  
  
  METHODS
  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. Trial registration Current Controlled Trials ISRCTN87144826.
authors.affiliation: Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH4 2XU, UK. p.andrews@ed.ac.uk
authors.forename: Peter J D
authors.initials: PJ
authors.lastname: Andrews
authors.forename: Alison
authors.initials: A
authors.lastname: Avenell
authors.forename: David W
authors.initials: DW
authors.lastname: Noble
authors.forename: Marion K
authors.initials: MK
authors.lastname: Campbell
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Croal
authors.forename: William G
authors.initials: WG
authors.lastname: Simpson
authors.forename: Luke D
authors.initials: LD
authors.lastname: Vale
authors.forename: Claire G
authors.initials: CG
authors.lastname: Battison
authors.forename: David J
authors.initials: DJ
authors.lastname: Jenkinson
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Cook
mesh_terms: D000368:Aged; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D003428:Cross Infection / Q000401:mortality / Q000517:prevention & control*; D019587:Dietary Supplements; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D005973:Glutamine / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D011788:Quality of Life; D012643:Selenium / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; D005973:Glutamine; D012643:Selenium