Barry, point taken - and as such most TPN given in the UK does contain
some selenium. However the story for critically ill adults in intensive
care is partly clouded due to the uncertainty surrounding the requirement,
utilisation and distribution of selenium in patients with severe acute
phase responses.
I would agree that given the likelyhood of underlying selenium deficiency
in the UK, then it perhaps makes good sense to supplement with high dose
selenium, however the bottom line is that there has not been a large
enough trial (see our Cochrane review and meta-analysis) providing
evidence to support the empirical thought that this improves outcome.
Hence the need for our trial.
A lot of things we do to critically ill patients might appear to be a good
idea based on empirical thought and physiological reasoning, however the
evidence needs to be sought that outcomes are changed. We would all accept
that giving TPN or other enteral nutritional support is essential in ITU
patients, however there is no good evidence even for this - in fact some
studies suggest that the metabolic load may in fact be detrimental.
Selenium and glutamine supplementation of TPN on balance are unlikely to
cause harm, however we must ensure that the theoretical benefit is
worthwhile both financially and in terms of patient outcomes.
Our study involves giving large doses of selenium (500ug/day) which also
adds another dimension. The SIGNET trial website does have a password to
get into the main sections (for participants only), however there is also
quite a lot of basic info on some of the accessible pages, including
patient sections. The other link quoted probably does not add much anyway.
Bernie
Dr Bernard L. Croal
Consultant Clinical Biochemist.
Clinical Senior Lecturer in Health Services Research.
Department of Clinical Biochemistry.
Aberdeen University Medical School.
Polwarth Building.
Aberdeen. UK.
AB25 2ZD.
Email: [log in to unmask]
Tel: +0044(0)1224552507
Fax: +0044(0)1224558841
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