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Reduction of nosocomial pneumonia after major burns by trace element supplementation: aggregation of two randomised trials

Berger, Mette M.; Eggimann, Philippe; Heyland, Daren K.; Chioléro, René L.; Revelly, Jean-Pierre; Day, Andrew; Raffoul, Wassim and Shenkin, Alan (2006) Reduction of nosocomial pneumonia after major burns by trace element supplementation: aggregation of two randomised trials. Critical Care, 10 . Article Number: R153. ISSN 1364-8535

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Abstract

Introduction Nosocomial pneumonia is a major source of morbidity and mortality after severe burns. Burned patients suffer trace element deficiencies and depressed antioxidant and immune defences. This study aimed at determining the effect of trace element supplementation on nosocomial or intensive care unit (ICU)-acquired pneumonia. Methods Two consecutive, randomised, double-blinded, supplementation studies including two homogeneous groups of 41 severely burned patients (20 placebo and 21 intervention) admitted to the burn centre of a university hospital were combined. Intervention consisted of intravenous trace element supplements (copper 2.5 to 3.1 mg/day, selenium 315 to 380 μg/day, and zinc 26.2 to 31.4 mg/day) for 8 to 21 days versus placebo. Endpoints were infections during the first 30 days (predefined criteria for pneumonia, bacteraemia, wound, urine, and other), wound healing, and length of ICU stay. Plasma and skin (study 2) concentrations of selenium and zinc were determined on days 3, 10, and 20. Results The patients, 42 ± 15 years old, were burned on 46% ± 19% of body surface: the combined characteristics of the patients did not differ between the groups. Plasma trace element concentrations and antioxidative capacity were significantly enhanced with normalisation of plasma selenium, zinc, and glutathione peroxidase concentrations in plasma and skin in the trace element-supplemented group. A significant reduction in number of infections was observed in the supplemented patients, which decreased from 3.5 ± 1.2 to 2.0 ± 1.0 episodes per patient in placebo group (p < 0.001). This was related to a reduction of nosocomial pneumonia, which occurred in 16 (80%) patients versus seven (33%) patients, respectively (p < 0.001), and of ventilator-associated pneumonia from 13 to six episodes, respectively (p = 0.023). Conclusion Enhancing trace element status and antioxidant defences by selenium, zinc, and copper supplementation was associated with a decrease of nosocomial pneumonia in critically ill, severely burned patients.

Item Type:Article
Additional Information:Published: 2 Nov 2006. 8 pages (page numbers not for citation purposes).
Uncontrolled Keywords:VENTILATOR-ASSOCIATED PNEUMONIA; CRITICALLY-ILL PATIENTS; BRONCHOALVEOLAR LAVAGE; LIPID-PEROXIDATION; RESPONSE SYNDROME; OXIDATIVE STRESS; SELENIUM; INJURY; COPPER; ZINC
Subjects:Q Science > QD Chemistry
Departments, Research Centres and Related Units:Academic Faculties, Institutes and Research Centres > Faculty of Medicine > School of Clinical Sciences
DOI:10.1186/cc5084
Publisher's Statement:© 2006 Berger et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Related URLs:
Refereed:Yes
Status:Published
ID Code:754
Deposited On:27 Jun 2008 16:43
Last Modified:22 Mar 2012 11:13

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