Pharmaconutrition with intravenous selenium in intensive care: The end of an era?

In cardiac surgery, during the instigation of a systemic inflammatory response by ischemia-reperfusion injuries and oxidative stress, the intraoperative decrease in serum Se is associated with postoperative development of multiorgan failure [8]. [...]HDIV Se supplementation seemed a promising strategy for patients with systemic inflammation; namely those with sepsis, trauma, and severe acute pancreatitis in the intensive care unit (ICU), as well as for cardiac surgery patients. According to previous findings in the literature and our a priori hypothesis, we conducted prespecified subgroup analyses and sensitivity analysis. In earlier studies, pharmaconutrition with HDIV seemed to be more effective in the subgroup of patients with high systemic inflammation as well as in the most critically ill patients. [...]we compared the RCT subgroups with a higher mortality rate with those with a lower mortality rate to isolate the sickest patients and we compared patients with sepsis with those who were not septic [3]. [...]this finding is questionable as no benefits were observed when HDIV Se was administered to septic patients. [...]in contradiction to the previously published literature, our most recent meta-analysis would suggest that daily HDIV Se, with or without an initial loading bolus, does not improve clinical outcomes and current evidence does not support the concept of pharmaconutrition with supraphysiological doses of HDIV Se.