Journal article
Effect of high-dose sodium selenite in cardiac surgery patients: A randomized controlled bi-center trial.
- Schmidt T Department for Anesthesia, Intensive Care Medicine and Rescue Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland. Electronic address: tanja.schmidt@luks.ch.
- Pargger H Department of Anesthesiology, Operative Intensive Care, Preclinical Emergency Medicine and Pain Management, University Hospital Basel, Switzerland. Electronic address: hans.pargger@usb.ch.
- Seeberger E Department of Anesthesiology, Operative Intensive Care, Preclinical Emergency Medicine and Pain Management, University Hospital Basel, Switzerland. Electronic address: esther.seeberger@usb.ch.
- Eckhart F Department for Anesthesia, Intensive Care Medicine and Rescue Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland. Electronic address: friedemann.eckhart@luks.ch.
- von Felten S Department of Clinical Research, Clinical Trial Unit, University Hospital Basel, Switzerland. Electronic address: stefanie.vonfelten@usb.ch.
- Haberthür C Department for Anesthesia, Intensive Care Medicine and Rescue Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland; Department of Anesthesiology and Intensive Care Medicine, Hirslanden Clinic, Zürich, Switzerland. Electronic address: christoph.haberthuer@hirslanden.ch.
- 2017-05-16
Published in:
- Clinical nutrition (Edinburgh, Scotland). - 2018
Bilirubin
Inflammation
Oxidative stress
Procalcitonin
Selenium
Vasoactive support
Acute Kidney Injury
Aged
Bilirubin
Cardiac Surgical Procedures
Female
Humans
Inflammation
Length of Stay
Male
Middle Aged
Oxidative Stress
Postoperative Complications
Procalcitonin
Protective Agents
Selenium
Sodium Selenite
English
BACKGROUND & AIMS
Cardiac surgery is accompanied by oxidative stress and systemic inflammatory response, which may be associated with organ dysfunction and increased mortality. Selenium and selenoenzymes are important constituents of anti-oxidative defense. We hypothesized that high-dose sodium selenite supplementation can attenuate the postoperative inflammation and might, therefore, improve clinical outcome.
METHODS
Randomized, placebo-controlled, double-blinded, bi-center study on 411 adult patients undergoing elective cardiac surgery. Patients received an intravenous bolus of 4000 μg selenium (in the form of sodium selenite) or placebo after induction of anesthesia and 1000 μg/d selenium or placebo during their intensive care unit (ICU) stay. Primary outcome measure was the Sequential Organ Failure Assessment (SOFA) score on the second postoperative day. Secondary endpoints included the change in perioperative selenium levels, change of inflammatory and cardiac markers, use of vasoactive medication, incidence of acute kidney injury, ICU and hospital length of stay, and mortality.
RESULTS
The perioperative administration of high-dose sodium selenite prevented the postoperative drop of blood and serum selenium levels, reduced the number of patients depending on postoperative vasoactive support but failed to reduce the postoperative SOFA score and its related organ-specific scores compared to placebo. Except for an increase of postoperative procalcitonin and bilirubin levels in the sodium selenite group, other inflammatory markers, organ function variables and clinical endpoints remained unchanged.
CONCLUSIONS
The perioperative administration of high-dose sodium selenite in cardiac surgery patients prevented the postoperative fall of blood selenium levels and reduced the need for postoperative vasoactive support by a yet unknown mechanism.
TRIAL REGISTRATION
Registered under ClinicalTrials.gov Identifier no. NCT01141556.
Cardiac surgery is accompanied by oxidative stress and systemic inflammatory response, which may be associated with organ dysfunction and increased mortality. Selenium and selenoenzymes are important constituents of anti-oxidative defense. We hypothesized that high-dose sodium selenite supplementation can attenuate the postoperative inflammation and might, therefore, improve clinical outcome.
METHODS
Randomized, placebo-controlled, double-blinded, bi-center study on 411 adult patients undergoing elective cardiac surgery. Patients received an intravenous bolus of 4000 μg selenium (in the form of sodium selenite) or placebo after induction of anesthesia and 1000 μg/d selenium or placebo during their intensive care unit (ICU) stay. Primary outcome measure was the Sequential Organ Failure Assessment (SOFA) score on the second postoperative day. Secondary endpoints included the change in perioperative selenium levels, change of inflammatory and cardiac markers, use of vasoactive medication, incidence of acute kidney injury, ICU and hospital length of stay, and mortality.
RESULTS
The perioperative administration of high-dose sodium selenite prevented the postoperative drop of blood and serum selenium levels, reduced the number of patients depending on postoperative vasoactive support but failed to reduce the postoperative SOFA score and its related organ-specific scores compared to placebo. Except for an increase of postoperative procalcitonin and bilirubin levels in the sodium selenite group, other inflammatory markers, organ function variables and clinical endpoints remained unchanged.
CONCLUSIONS
The perioperative administration of high-dose sodium selenite in cardiac surgery patients prevented the postoperative fall of blood selenium levels and reduced the need for postoperative vasoactive support by a yet unknown mechanism.
TRIAL REGISTRATION
Registered under ClinicalTrials.gov Identifier no. NCT01141556.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.clnu.2017.04.019
- PMID 28502744
- Persistent URL
- https://folia.unifr.ch/global/documents/270521
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