Utilização de imunonutrientes em pacientes críticos sépticos: uma revisão de evidências científicas
DOI:
https://doi.org/10.29237/2358-9868.2017v5i2.p112-120Resumo
Objetivo: revisar as evidências científicas sobre a utilização de imunonutrientes em pacientes sépticos. Fonte de dados: As buscas bibliográficas foram realizadas nas bases de dados Pubmed, Scielo, Bireme e Scopus com recorte temporal na língua inglesa, portuguesa e espanhola. Síntese dos dados: Após analise dos estudos recomenda-se que a glutamina enteral ou parenteral não seja utilizada em pacientes críticos, com exceção para pacientes queimados. Em relação a arginina não há estudos prospectivos, controlados e randomizados publicados utilizando arginina como agente isolado na sepse nos últimos cinco anos. No caso de ômega 3, a maioria dos estudos avalia o efeito associado a antioxidantes, portanto não é possível estabelecer uma indicação específica do nutriente. O mesmo ocorre com suplementação de vitaminas associadas ao selênio. Conclusão: Não houve um senso comum quanto à recomendação de imunonutrientes entre os artigos analisados. São necessários mais estudos para definir dose, via de administração e o momento ideal para a administração de cada imunomodulador em subgrupos de pacientes críticos sépticos.
Referências
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3. Chetty S. The do’s and dont’s of arginine supplementation. S Afr J Clin Nutr. 2010;23(1):S25-28.
4. Çehmen N, Aydin A, Erdemli O. The impact of L-alanyl-L-glutamine dipeptide supplemented total parenteral nutrition on clinical outcome in critically patients.e-SPEN.2011;6: e64-e67.
5. Chen QH, Yang Y, He HL, Xie JF, Cai SX, Liu AR, et al. The effect of glutamine therapy on outcomes in critically ill patients: a meta-analysis of randomized controlled trials. Critical Care.2014; 18:R8.
6. Hegazi R, Wischmeyer P. Clinical review: optimizing enteral nutrition for critically ill patients – a simple data-driven formula. Critical Care.2011; 15: 234.
7. Pérez-Bárcena J, Crespí C, Regueiro V, Marsé P, M Raurich J, Ibáñez J, et al. Lack of effect of glutamine administration to boost the innate immune system response in trauma patients in the intensive care unit. Critical Care.2010;14:R233.
8. Van Zanten A, Dhaliwal R, Garrel D, Heyland D. Enteral glutamine supplementation in critically ill patients: a systematic review and meta-analysis. Critical Care.2015;19:294.
9. Uranjek J, Vovk I, Kompan L. Effect of the route of glutamine supplementation (enteral versus parenteral) on intestinal permeability on surgical intensive care unit patients: a pilot study. Surgical Practice.2013;17:153-160.
10. Wang Y1, Jiang ZM, Nolan MT, Jiang H, Han HR, Yu K , et al. The impact of glutamine dipeptide-supplemented parenteral nutrition on outcomes of surgical patients: a meta-analysis of randomized clinical trials. JPEN J Parenter Enteral Nutr.2010;34(5):521-9.
11. Rousseau A, Losser M, Ichai C. ESPEN endorsed recommendations: nutritional therapy in major burns. Critical Nutrition.2013;32:497-502.
12. Grau T, Bonet A, Miñambres E, Piñeiro L, Irles JA, Robles A , et al. The effect of L-alanyl – L- glutamine dipeptide supplemented total parenteral nutrition on infectious morbidity and insulin sensitivity in critically ill patients.Critical Care Medicine.2011;39(6):1263-1268.
13. Grintescu IM, Luca Vasiliu I, Cucereanu Badica I, Mirea L, Pavelescu D, Balanescu A , et al. The influence of parenteral glutamine supplementation on glucose homeostasis in critically ill polytrauma patients – a randomized- controlled clinical study.Clin Nutr.2015;34(3):377-82.
14. Wernerman J, Kirketeig T, Andersson B, Berthelson H, Ersson A, Friberg H, et al. Scandinavian glutamine trial: a pragmatic multi-centre randomised clinical trial of intensive care unit patients. Acta Anaesthesiol Scand.2011;55:812-818.
15. Daren Heyland, M.D., John Muscedere, M.D., Paul E. Wischmeyer, M.D., Deborah Cook, M.D., Gwynne Jones, M.D., Martin Albert, M.D , et al. A randomized trial of glutamine and antioxidants in critically ill patients. N Engl J Med.2013;368:1489-1497.
16. Critical Care Nutrition. 2015 Canadian Clinical Practice Guidelines. Disponível em: http://www.criticalcarenutrition.com.
17. Kreymanna K.G, Bergerb M.M, Deutzc N.E.P, Hiesmayrd M, Jolliete P, Kazandjievf G, et al. ESPEN Guidelines on Enteral Nutrition: Intensive care. Clinical Nutrition. 2006;25:210-223.
18. Singer P, M. Berger M , Berghe GVD , Biolo G, Calder P , Forbes A ,, et al. ESPEN Guidelines on Parenteral Nutrition: Intensive care. Clinical Nutrition. 2009;28:387–400.
19. McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, et al. ASPEN. Board of Directors, American College of Critical Care Medicine, Society of Critical Care Medicine. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patients: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). JPEN J Parenter Enteral Nutr.2009;33(3):277-316.
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21. Andrews PJ, Avenell A, Noble DW, Campbell MK, Croal BL, Simpson WG , et al. Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients.BMJ.2011;342:d1542.
22. Perez-Barcena J, et al. A randomized trial of intravenous glutamine supplementation in trauma ICU patients. Intensive Care Med.2014;40(4):539-47.
23. Koksal G, et al. The effects of intravenous, enteral and combined administration of glutamine on malnutrition in sepsis: a randomized clinical trial. Asia Pac J Clin Nutr.2014;23(1):34-40.
24. Davis JS, Anstey NM. Is plasma arginine concentration decreased in patients with sepsis? A systematic review and meta- analysis. Crit Care Med.2011;39 (2):380-5.
25. Drover J, et al. Perioperative use of arginine-supplemented diets: a systematic review of the evidence. Journal of the American College of Surgeons. 2011;212(3):385-399.
26. Marimuthu K, Varadhan KK, Ljungqvist O, Lobo DN . A meta-analysis of the effect of combinations of immune modulating nutrients on outcome in patients undergoing major open gastrointestinal surgery. Ann Surg.2012;255(6):1060-8.
27. Osland E, et al. Effect of timing of pharmaconutrition (immunonutrition) administration on outcomes of elective surgery for gastrointestinal malignances: a systematic review and meta-analysis. JPEN J Parenter Enteral Nutr.2014;38(1):53-69.
28. Rice T, Wheeler A, Thompson B, P.deBoisblanc B, Steingrub J, Rock P. Enteral Omega-3 fatty acid, - linolenic acid, and antioxidant supplementation in acute lung injury. JAMA. 2011;306(14):1574-1581.
29. Grau-Carmona T, Morán-García V, García-de-Lorenzo A, Heras-de-la-Calle G, Quesada-Bellver B, López-Martínez J, , et al. Effect of an enteral diet enriched with eicosapentaenoic acid, gamma – linolenic acid and anti-oxidants on the outcome of mechanically ventilated, critically ill, septic patients. Clinical Nutrition. 2011;30(5):578-84.
30. Pontes-Arruda A, Martins LF, Lima SM, Isola AM, Toledo D, Rezende E, et al. Enteral nutrition with eicosapentaenoic acid, - linolenic acid and oxidants in the early treatment of sepsis: results from a multicenter, prospective, randomized, double – blinded, controlled study: the INTERSEPT study. Critical Care.2011;15:R44.
31. Manzanares W, Dhaliwal R, Jurewitsch B, Stapleton RD, Jeejeebhoy KN, Heyland DK. . Parenteral fish oil lipid emulsions in the critically ill: a systematic review and meta-analysis. JPEN J Parenter Enteral Nutr.2014; 38(1):20-28.
32. Parish M, Valiyi F, Hamishehkar H, Sanaie S, Asghari Jafarabadi M, Golzari SE , et al. The effect of omega - 3 fatty acids on ARDS: a randomized double-blind study. Adv Pharm Bull.2014;4:555-561.
33. Stapleton RD, Martin TR, Weiss NS, Crowley JJ, Gundel SJ, Nathens AB, et al. A phase II randomized placebo – controlled trial of omega-3 fatty acids for the treatment of acute lung injury. Crit Care Med. 2011;39 (7): 1655-1662.
34. Elamin E, Miller A, Ziad S. Immune enteral nutrition can improve outcomes in medical-surgical patients with ARDS: a prospective randomized controlled trial. J Nutr Disord Ther.2012;2:109.
35. Theilla M1, Schwartz B, Zimra Y, Shapiro H, Anbar R, Rabizadeh E , et al. Enteral n-3 fatty acids and micronutrients enhance percentage of positive neutrophil and lymphocyte adhesion molecules: a potential mediator of pressure ulcer healing in critically ill patients. British Journal of Nutrition. 2012;107:1056-1061.
36. Zhu D1, Zhang Y, Li S, Gan L, Feng H, Nie W.Enteral omega-3 fatty acid supplementation in adult patients with acute respiratory distress syndrome: a systematic review of randomized controlled trials with meta-analysis and trial sequential analysis. Intensive Care Med.2014;40(4):504-12.
37. Kagan I1, Cohen J, Stein M, Bendavid I, Pinsker D, Silva V , et al. Preemptive enteral nutrition enriched with eicosapentaenoic acid, gamma-linolenic acid and antioxidants in severe multiple trauma: a prospective, randomized, double-blind study. Intensive Care Med.2015; 41(3):460-9.
38. Barbosa V, Miles E, Calhau C, Lafuente E, Calder P. Effects of fish oil containing lipid emulsion on plasma phospholipid fatty acids, inflammatory markers, and clinical outcomes in septic patients: a randomized, controlled clinical trial. Critical Care.2010;14: R5.
39. Sabater J et al. Effects of an omega-3 fatty acid-enriched lipid emulsion on eicosanoid synthesis in acute respiratory distress syndrome (ARDS): a prospective, randomized, double-blind, parallel group study. Nutrition & Metabolism.2011;8:22.
40. Pradelli L, Mayer K, Muscaritoli M, Heller A. N-3 fatty acid enriched parenteral nutrition regimes in elective surgical and ICU patients: a meta-analysis. Critical Care.2012;16:R184.
41. Palmer AJ, Ho CK, Ajibola O, Avenell A. The role of -3 supplemented parenteral nutrition in critical illness in adults: a systematic review & meta-analysis. Crit Care Med.2013;41(1):307-16.
42. Hall TC, Bilku DK, Al-Leswas D, Neal CP, Horst C, Cooke J, et al. A randomized controlled trial investigating the effects of parenteral fish oil on survival outcomes in critically ill patients with sepsis: a pilot study. JPEN J Parenter Enteral Nutr.2015;39(3):301-12.
43. Manzanares W, Dhaliwal R, Jiang X, Murch L, Heyland DK. Antioxidant micronutrients in the critically ill: a systematic review and meta-analysis. Critical Care. 2012;16:R66.
44. Nogueira CR, Borges F, Lameu E, Franca C, Ramalho A. Effects of supplementation of antioxidant vitamins and lipid peroxidation in critically ill patients. Nutr Hosp.2013; 28(5):1666-1672.
45. Schneider A, Markowski A, Momma M, Seipt C, Luettig B, Hadem J, et al. Tolerability and efficacy of a low-volume enteral supplement containing key nutrients in the critically ill. 2011;30(5):599-603.
46. Chelkeba L,Ahmadi A, Abdollahi M, Najafi A, Ghadimi MH, Mosaed R, et al. The effect of parenteral selenium on outcomes of mechanically ventilated patients following sepsis: a prospective randomized clinical trial. Ann. Intensive Care.2015;5:29.
47. Manzanares W, Langlois PL, Heyland DK. Pharmaconutrition with selenium in critically ill patients: what do we know? Nutr Clin Pract.2015;30(1):34-43.
48. Valenta J, Brodska H, Drabek T, Hendl J, Kazda A. High-dose selenium substitution in sepsis: a prospective randomized clinical trial.Intensive Care Med. 2011;37(5):808-15.
49. Manzanares W, Biestro A, Torre MH, Galusso F, Facchin G, Hardy G. High-dose selenium reduces ventilator-associated pneumonia and illness severity in critically ill patients with systemic inflammation. Intensive Care Med.2011; 37(7):1120-7.
50. Alhazzani W, Jacobi J, Sindi A, Hartog C, Reinhart K, Kokkoris S, et al. The effect of selenium therapy on mortality in patients with sepsis syndrome: a systematic review and meta-analysis of randomized controlled trials. Crit Care Med.2013;41(6):1555-64.
51. Landucci F, Mancinelli P, De Gaudio AR, Virgili G. Selenium supplementation in critically ill patients: a systematic review and meta-analysis.J Crit Care. 2014;29(1):150-6.
52. Sakr Y, Maia VPL, Santos C, Stracke J, Zeidan M, Bayer O, et al. Adjuvant selenium supplementation in the form of sodium selenite in postoperative critically ill patients with severe sepsis. Critical Care. 2014;18:R18.
53. Woth G, Nagy B2, Mérei Á2, Ernyey B3, Vincze R3, Kaurics Z3, et al. The effect of Na-selenite treatment on the oxidative stress-antioxidants balance of multiple organ failure.J Crit Care.2014; 29(5):883.e7-11.
2. Van Zanten AR, Sztark F, Kaisers UX, Zielmann S, Felbinger TW, Sablotzki AR, et al. High-protein enteral nutrition enriched with immune-modulating nutrients vs standard high-protein enteral nutrition and nosocomial infections in the ICU: a randomized clinical trial.JAMA.2014;312(5):514-524.
3. Chetty S. The do’s and dont’s of arginine supplementation. S Afr J Clin Nutr. 2010;23(1):S25-28.
4. Çehmen N, Aydin A, Erdemli O. The impact of L-alanyl-L-glutamine dipeptide supplemented total parenteral nutrition on clinical outcome in critically patients.e-SPEN.2011;6: e64-e67.
5. Chen QH, Yang Y, He HL, Xie JF, Cai SX, Liu AR, et al. The effect of glutamine therapy on outcomes in critically ill patients: a meta-analysis of randomized controlled trials. Critical Care.2014; 18:R8.
6. Hegazi R, Wischmeyer P. Clinical review: optimizing enteral nutrition for critically ill patients – a simple data-driven formula. Critical Care.2011; 15: 234.
7. Pérez-Bárcena J, Crespí C, Regueiro V, Marsé P, M Raurich J, Ibáñez J, et al. Lack of effect of glutamine administration to boost the innate immune system response in trauma patients in the intensive care unit. Critical Care.2010;14:R233.
8. Van Zanten A, Dhaliwal R, Garrel D, Heyland D. Enteral glutamine supplementation in critically ill patients: a systematic review and meta-analysis. Critical Care.2015;19:294.
9. Uranjek J, Vovk I, Kompan L. Effect of the route of glutamine supplementation (enteral versus parenteral) on intestinal permeability on surgical intensive care unit patients: a pilot study. Surgical Practice.2013;17:153-160.
10. Wang Y1, Jiang ZM, Nolan MT, Jiang H, Han HR, Yu K , et al. The impact of glutamine dipeptide-supplemented parenteral nutrition on outcomes of surgical patients: a meta-analysis of randomized clinical trials. JPEN J Parenter Enteral Nutr.2010;34(5):521-9.
11. Rousseau A, Losser M, Ichai C. ESPEN endorsed recommendations: nutritional therapy in major burns. Critical Nutrition.2013;32:497-502.
12. Grau T, Bonet A, Miñambres E, Piñeiro L, Irles JA, Robles A , et al. The effect of L-alanyl – L- glutamine dipeptide supplemented total parenteral nutrition on infectious morbidity and insulin sensitivity in critically ill patients.Critical Care Medicine.2011;39(6):1263-1268.
13. Grintescu IM, Luca Vasiliu I, Cucereanu Badica I, Mirea L, Pavelescu D, Balanescu A , et al. The influence of parenteral glutamine supplementation on glucose homeostasis in critically ill polytrauma patients – a randomized- controlled clinical study.Clin Nutr.2015;34(3):377-82.
14. Wernerman J, Kirketeig T, Andersson B, Berthelson H, Ersson A, Friberg H, et al. Scandinavian glutamine trial: a pragmatic multi-centre randomised clinical trial of intensive care unit patients. Acta Anaesthesiol Scand.2011;55:812-818.
15. Daren Heyland, M.D., John Muscedere, M.D., Paul E. Wischmeyer, M.D., Deborah Cook, M.D., Gwynne Jones, M.D., Martin Albert, M.D , et al. A randomized trial of glutamine and antioxidants in critically ill patients. N Engl J Med.2013;368:1489-1497.
16. Critical Care Nutrition. 2015 Canadian Clinical Practice Guidelines. Disponível em: http://www.criticalcarenutrition.com.
17. Kreymanna K.G, Bergerb M.M, Deutzc N.E.P, Hiesmayrd M, Jolliete P, Kazandjievf G, et al. ESPEN Guidelines on Enteral Nutrition: Intensive care. Clinical Nutrition. 2006;25:210-223.
18. Singer P, M. Berger M , Berghe GVD , Biolo G, Calder P , Forbes A ,, et al. ESPEN Guidelines on Parenteral Nutrition: Intensive care. Clinical Nutrition. 2009;28:387–400.
19. McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, et al. ASPEN. Board of Directors, American College of Critical Care Medicine, Society of Critical Care Medicine. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patients: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). JPEN J Parenter Enteral Nutr.2009;33(3):277-316.
20. Nunes ALB, Koterba E, Alves VGF, Abrahão V, Correia MITD. Terapia nutricional no paciente grave. Projeto Diretrizes – DITEN. Disponível em: http://www.projetodiretrizes.org.br.
21. Andrews PJ, Avenell A, Noble DW, Campbell MK, Croal BL, Simpson WG , et al. Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients.BMJ.2011;342:d1542.
22. Perez-Barcena J, et al. A randomized trial of intravenous glutamine supplementation in trauma ICU patients. Intensive Care Med.2014;40(4):539-47.
23. Koksal G, et al. The effects of intravenous, enteral and combined administration of glutamine on malnutrition in sepsis: a randomized clinical trial. Asia Pac J Clin Nutr.2014;23(1):34-40.
24. Davis JS, Anstey NM. Is plasma arginine concentration decreased in patients with sepsis? A systematic review and meta- analysis. Crit Care Med.2011;39 (2):380-5.
25. Drover J, et al. Perioperative use of arginine-supplemented diets: a systematic review of the evidence. Journal of the American College of Surgeons. 2011;212(3):385-399.
26. Marimuthu K, Varadhan KK, Ljungqvist O, Lobo DN . A meta-analysis of the effect of combinations of immune modulating nutrients on outcome in patients undergoing major open gastrointestinal surgery. Ann Surg.2012;255(6):1060-8.
27. Osland E, et al. Effect of timing of pharmaconutrition (immunonutrition) administration on outcomes of elective surgery for gastrointestinal malignances: a systematic review and meta-analysis. JPEN J Parenter Enteral Nutr.2014;38(1):53-69.
28. Rice T, Wheeler A, Thompson B, P.deBoisblanc B, Steingrub J, Rock P. Enteral Omega-3 fatty acid, - linolenic acid, and antioxidant supplementation in acute lung injury. JAMA. 2011;306(14):1574-1581.
29. Grau-Carmona T, Morán-García V, García-de-Lorenzo A, Heras-de-la-Calle G, Quesada-Bellver B, López-Martínez J, , et al. Effect of an enteral diet enriched with eicosapentaenoic acid, gamma – linolenic acid and anti-oxidants on the outcome of mechanically ventilated, critically ill, septic patients. Clinical Nutrition. 2011;30(5):578-84.
30. Pontes-Arruda A, Martins LF, Lima SM, Isola AM, Toledo D, Rezende E, et al. Enteral nutrition with eicosapentaenoic acid, - linolenic acid and oxidants in the early treatment of sepsis: results from a multicenter, prospective, randomized, double – blinded, controlled study: the INTERSEPT study. Critical Care.2011;15:R44.
31. Manzanares W, Dhaliwal R, Jurewitsch B, Stapleton RD, Jeejeebhoy KN, Heyland DK. . Parenteral fish oil lipid emulsions in the critically ill: a systematic review and meta-analysis. JPEN J Parenter Enteral Nutr.2014; 38(1):20-28.
32. Parish M, Valiyi F, Hamishehkar H, Sanaie S, Asghari Jafarabadi M, Golzari SE , et al. The effect of omega - 3 fatty acids on ARDS: a randomized double-blind study. Adv Pharm Bull.2014;4:555-561.
33. Stapleton RD, Martin TR, Weiss NS, Crowley JJ, Gundel SJ, Nathens AB, et al. A phase II randomized placebo – controlled trial of omega-3 fatty acids for the treatment of acute lung injury. Crit Care Med. 2011;39 (7): 1655-1662.
34. Elamin E, Miller A, Ziad S. Immune enteral nutrition can improve outcomes in medical-surgical patients with ARDS: a prospective randomized controlled trial. J Nutr Disord Ther.2012;2:109.
35. Theilla M1, Schwartz B, Zimra Y, Shapiro H, Anbar R, Rabizadeh E , et al. Enteral n-3 fatty acids and micronutrients enhance percentage of positive neutrophil and lymphocyte adhesion molecules: a potential mediator of pressure ulcer healing in critically ill patients. British Journal of Nutrition. 2012;107:1056-1061.
36. Zhu D1, Zhang Y, Li S, Gan L, Feng H, Nie W.Enteral omega-3 fatty acid supplementation in adult patients with acute respiratory distress syndrome: a systematic review of randomized controlled trials with meta-analysis and trial sequential analysis. Intensive Care Med.2014;40(4):504-12.
37. Kagan I1, Cohen J, Stein M, Bendavid I, Pinsker D, Silva V , et al. Preemptive enteral nutrition enriched with eicosapentaenoic acid, gamma-linolenic acid and antioxidants in severe multiple trauma: a prospective, randomized, double-blind study. Intensive Care Med.2015; 41(3):460-9.
38. Barbosa V, Miles E, Calhau C, Lafuente E, Calder P. Effects of fish oil containing lipid emulsion on plasma phospholipid fatty acids, inflammatory markers, and clinical outcomes in septic patients: a randomized, controlled clinical trial. Critical Care.2010;14: R5.
39. Sabater J et al. Effects of an omega-3 fatty acid-enriched lipid emulsion on eicosanoid synthesis in acute respiratory distress syndrome (ARDS): a prospective, randomized, double-blind, parallel group study. Nutrition & Metabolism.2011;8:22.
40. Pradelli L, Mayer K, Muscaritoli M, Heller A. N-3 fatty acid enriched parenteral nutrition regimes in elective surgical and ICU patients: a meta-analysis. Critical Care.2012;16:R184.
41. Palmer AJ, Ho CK, Ajibola O, Avenell A. The role of -3 supplemented parenteral nutrition in critical illness in adults: a systematic review & meta-analysis. Crit Care Med.2013;41(1):307-16.
42. Hall TC, Bilku DK, Al-Leswas D, Neal CP, Horst C, Cooke J, et al. A randomized controlled trial investigating the effects of parenteral fish oil on survival outcomes in critically ill patients with sepsis: a pilot study. JPEN J Parenter Enteral Nutr.2015;39(3):301-12.
43. Manzanares W, Dhaliwal R, Jiang X, Murch L, Heyland DK. Antioxidant micronutrients in the critically ill: a systematic review and meta-analysis. Critical Care. 2012;16:R66.
44. Nogueira CR, Borges F, Lameu E, Franca C, Ramalho A. Effects of supplementation of antioxidant vitamins and lipid peroxidation in critically ill patients. Nutr Hosp.2013; 28(5):1666-1672.
45. Schneider A, Markowski A, Momma M, Seipt C, Luettig B, Hadem J, et al. Tolerability and efficacy of a low-volume enteral supplement containing key nutrients in the critically ill. 2011;30(5):599-603.
46. Chelkeba L,Ahmadi A, Abdollahi M, Najafi A, Ghadimi MH, Mosaed R, et al. The effect of parenteral selenium on outcomes of mechanically ventilated patients following sepsis: a prospective randomized clinical trial. Ann. Intensive Care.2015;5:29.
47. Manzanares W, Langlois PL, Heyland DK. Pharmaconutrition with selenium in critically ill patients: what do we know? Nutr Clin Pract.2015;30(1):34-43.
48. Valenta J, Brodska H, Drabek T, Hendl J, Kazda A. High-dose selenium substitution in sepsis: a prospective randomized clinical trial.Intensive Care Med. 2011;37(5):808-15.
49. Manzanares W, Biestro A, Torre MH, Galusso F, Facchin G, Hardy G. High-dose selenium reduces ventilator-associated pneumonia and illness severity in critically ill patients with systemic inflammation. Intensive Care Med.2011; 37(7):1120-7.
50. Alhazzani W, Jacobi J, Sindi A, Hartog C, Reinhart K, Kokkoris S, et al. The effect of selenium therapy on mortality in patients with sepsis syndrome: a systematic review and meta-analysis of randomized controlled trials. Crit Care Med.2013;41(6):1555-64.
51. Landucci F, Mancinelli P, De Gaudio AR, Virgili G. Selenium supplementation in critically ill patients: a systematic review and meta-analysis.J Crit Care. 2014;29(1):150-6.
52. Sakr Y, Maia VPL, Santos C, Stracke J, Zeidan M, Bayer O, et al. Adjuvant selenium supplementation in the form of sodium selenite in postoperative critically ill patients with severe sepsis. Critical Care. 2014;18:R18.
53. Woth G, Nagy B2, Mérei Á2, Ernyey B3, Vincze R3, Kaurics Z3, et al. The effect of Na-selenite treatment on the oxidative stress-antioxidants balance of multiple organ failure.J Crit Care.2014; 29(5):883.e7-11.
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2017-12-18
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