Micronutrients in adult critically ill patients: scoping review on parenteral supplementation
DOI:
https://doi.org/10.35454/rncm.v7n3.637Keywords:
critical care, micronutrients, trace elements, vitamins, electrolytes, reviewAbstract
Introduction: it is estimated that the prevalence of malnutrition among hospi- talized patients is between 30.00 % and 50.00 %. Objective: to examine the published evidence regarding the necessary intake of micronutrients and calcium in adult cri- tically ill patients. Methods: between January and November 2023, a search was conducted in various databases of scientific litera- ture without imposing strict limitations. The search primarily focused on meta- analyses, randomized clinical trials, and systematic reviews. Results: selenium administration corre- lates with the severity of sepsis; however, a recommendation cannot be established. Zinc doses in trace element solutions are suggested to be deficient, with their provi- sion associated with lower hospital mortali- ty. Calcium supplementation may improve 28-day survival, with its deficiency linked to higher mortality. However, if hypocalcemia is mild or asymptomatic, supplementation is not recommended. Similarly, results obtained regarding the various analyzed vitamins (C, D, E) indicate that supplemen- tation cannot be recommended. Conclusions: the provision of low do- ses of trace elements and vitamins is safe and justified. Regarding vitamins E, D, se- lenium, and zinc, there are contradictory studies, and no precise recommendation is established for patients with increased requirements. High-dose vitamin C admi- nistration does not appear to present any significant clinical effect in septic patients. No guideline recommends supplemen- ting mild hypocalcemia.
Downloads
References
Calvo-Hernández MJ, Sirvent-Ochando M, Caba-Porras I, Cervera-Peris M. Valoración nutricional. Estandarización del soporte nutricional especializado. Farm Hosp. 2009; 33 (1): 5-6.
Arias-Núñez MC. La desnutrición en el paciente hospitalizado. Principios básicos de aplicación de la nutrición artificial. Guías clínicas de la sociedad gallega de medicina interna. Complejo Hospitalario Xeral. Lugo. 2018: 179-210.
Ulibarri-Pérez JI, Picón-César MJ, García-Benavent E. Detección precoz y control de la desnutrición hospitalaria. Nutr. Hosp. 2012; 17 (3):139-46.
Hendricks KM, Duggan C, Gallagher L, Carlin AC, Richardson DS, Collier SB, et al. Malnutrition in hospitalized pediatric patients: Current prevalence. Arch Pediatr Adolesc Med. 1995; 149 (10): 1118-22. doi: 10.1001/archpedi.1995.02170230072010.
Suárez de la Rica A. Nutrición en el paciente crítico. En: Sistac Baleerin JM, Aldecoa Alvarez de Santullano C, editores. Curso online de reanimación: cuidados críticos médicos quirúrgicos. Madrid: Medica panamericana; 2023. p. 1-12.
Zamora-Elson M, Martínez-Carmona JF, Ruiz-Santana S. Recomendaciones para el tratamiento nutrometabólico especializado del paciente crítico. Grupo de Trabajo de Metabolismo y Nutrición de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC). Med. intensiva. 2020; 44 (1): 19-23. doi: 10.1016/j.medin.2020.01.007.
Rendón-Rodríguez R , Torres-Wong AS , Uresti-González II. Nutrición enteral en el paciente crítico con inestabilidad hemodinámica. Nutr Clin Med. 2019; 13 (2): 73-88. doi: 10.7400/NCM.2019.13.2.5074.
Herranz S, Álvarez V, Frutos D, Blasco M, García C, Fernández G. Soporte nutricional con nutrición parenteral. Evolución y complicaciones asociadas. Endocrinol Nutr. 2013; 60 (6): 287-93. doi: 10.1016/j.endonu.2012.12.010.
García de Lorenzo A, Álvarez J, Bermejo T, Gomis P, Piñeiro G. Micronutrientes en nutrición parenteral. Nutr. Hosp. 2009; 24 (2): 152-55.
Martí-Bonmatí E, Pérez-Felíu A, Valero-Tellería A. Adicción de vitaminas y oligoelementos a la nutrición parenteral. Farm. Hosp. 201; 35 (2): 96-7.
Ortiz-Leyba C, Gómez-Tello V, Serón-Arbeloa C. Requerimientos de macronutrientes y micronutrientes. Nutr Hosp 2005; 20 (2): 13-7.
Muñoz-García M, Pérez-Menéndez-Conde C, Bermejo-Vicedo T. Revisión Avances en el conocimiento del uso de micronutrientes en nutrición artificial. Nutr Hosp. Nutr Hosp. 2011; 26 (1): 37-47.
Koekkoek WA, van Zanten AR. Antioxidant Vitamins and Trace Elements in Critical Illness. Nutr Clin Pract. 2016; 31 (4): 457-74. doi: 10.1177/0884533616653832.
Li S, Tang T, Guo P, Zou Q, Ao X, Hu L, et al. A meta-analysis of randomized controlled trials. Medicina. 2019; 98 (9): E14733. doi: 10.1097/MD.0000000000014733.
De Waele E, Malbrain MLNG, Spapen H. Nutrition in Sepsis: A Bench-to-Bedside Review. Nutrients. 2020; 12 (2): 395. doi: 10.3390/nu12020395.
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 systema- tic review and meta-analysis of randomized controlled trials. Crit. Care Med. 2013;41(6):1555-64. doi: 10.1097/ CCM.0b013e31828a24c6
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. doi: 10.1016/j.jcrc.2013.08.017
Ting-Shuo H, Yu-Chiau S, Huang-Yang C, Li-Mei L, Chia-Ying L, Shin-Sheng Y, et al. Effect of parenteral selenium supple- mentation in critically ill patients: A Systematic Review and Meta-Analysis. PLoS One. 2013;8(1):e54431. doi: 10.1371/ journal.pone.0054431
Huang TS, Shyu YC, Chen HY, Lin LM, Lo CY, Yuan SS, et al. Effect of parenteral selenium supplementation in critically ill patients: a systematic review and meta-analysis. PLoS One. 2013;8(1):e54431. doi: 10.1371/journal.pone.0054431
Mousavi MA, Saghaleini SH, Mahmoodpoor A, Ghojazadeh M, Mousavi SN. Daily parenteral selenium therapy in critically ill patients: An updated systematic review and meta-analysis of randomized controlled trials. Clin Nutr ESPEN. 2021;41:49- 58. doi: 10.1016/j.clnesp.2020.11.026
Cander B, Dundar ZD, Gul M, Girisgin S. Prognostic value of serum zinc levels in critically ill patients. J Crit Care. 2011;26(1):42-46. doi: 10.1016/j.jcrc.2010.06.002
Crespo-Martínez C, Sirvent-Ochando M, Vázquez-Polo A, Caba-Porras I, Romero-Jiménez RM, Tejada-González P. Encuesta sobre el uso de sulfato de zinc en nutrición paren- teral en hospitales españoles. Farm Hosp. 2017;42(2):68-72. doi: 10.7399/FH.10855
Xia W, Li C, Zhao D, Xu L, Kuang M, Yao X, et al. The impact of zinc supplementation on critically ill patients with acute kid- ney injury: a propensity score matching analysis. Front Nutr. 2022;9:894572. https://doi.org/10.3389/fnut.2022.894572
Forsythe RM, Wessel CB, Billiar TR, Angus DC, Rosengart MR. Parenteral calcium for intensive care unit patients. Cochrane Database Syst Rev. 2008;(4):CD006163. doi: 10.1002/14651858.CD006163.pub2
Steele T, Kolamunnage-Dona R, Downey C, Toh CH, Welters I. Assessment and clinical course of hypocalcemia in critical illness. Crit Care. 2013;17(3):R106. doi: 10.1186/cc12756
Zhang Z, Chen K, Ni H. Calcium supplementation impro- ves clinical outcome in intensive care unit patients: a pro- pensity score matched analysis of a large clinical database MIMIC-II. SpringerPlus. 2015;4:594. doi:10.1186/s40064- 015-1387-7
Berger MM, Eggimann P, Heyland DK, Chioléro RL, Revelly JP, Day A, et al. Reduction of nosocomial pneumonia after major burns by trace element supplementation: aggregation of two randomised trials. Crit Care. 2006;10(6):153-65. doi: 10.1186/cc5084
Jafari P, Thomas A, Haselbach D, Watfa W, Pantet O, Michetti M, et al. Trace element intakes should be revisited in burn nutri- tion protocols: A cohort study. Clin Nutr. 2018;37(3):958-64. doi: 10.1016/j.clnu.2017.03.028
Chen LR, Yang BS, Chang CN, Yu CM, Chen KH. Additional Vitamin and Mineral Support for Patients with Severe Burns: A Nationwide Experience from a Catastrophic Color-Dust Explosion Event in Taiwan. Nutrients. 2018;10(11):1782. doi: 10.3390/nu10111782
Fowler AA III, Syed AA, Knowlson S, Sculthorpe R, Farthing D, DeWilde C, et al. Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis. J Transl Med. 2014;12:32. doi: 10.1186/1479-5876-12-32
Sadeghpour A, Alizadehasl A, Kyavar M et al, Impact of Vitamin C Supplementation on Post-Cardiac Surgery ICU and Hospital Length of Stay. Anesth Pain Med. 2015;5(1):e25337. doi: 10.5812/aapm.25337
Sevransky JE, Rothman RE, Hager DN, Bernard GR, Brown SM, Buchman TG, et al. VICTAS Investigators. Effect of Vitamin C, Thiamine, and Hydrocortisone on Ventilator- and Vasopressor-Free Days in Patients With Sepsis: The VICTAS Randomized Clinical Trial. JAMA. 2021;325(8):742-50. doi: 10.1001/jama.2020.24505
Lamontagne MD, Mase MH, Menard J, Sprague S, Pinto R, Heyland DK, et al. Intravenous vitamin C in adults with sepsis in the intensive care unit. N Engl J Med. 2022;386(25):2387- 98. doi: 10.1056/NEJMoa2200644
Dang H, Li J, Liu C, Xu F. The association between vita- min E deficiency and critically ill children with sepsis and septic shock. Front Nutr. 2021;8:648442. doi: 10.3389/ fnut.2021.648442
Shen H, Zhan B. Effect of vitamin E on stroke-associated pneumonia. J Int Med Res. 2020;48(9):300060520949657. doi: 10.1177/0300060520949657
Lassnigg A, Punz A, Barker R, Keznickl P, Manhart N, Roth E, et al. Influence of intravenous vitamin E supplementation in cardiac surgery on oxidative stress: a doubleblinded, randomi- zed, controlled study. Br J Anaesth. 2003;90(2):148-54. doi: 10.1093/bja/aeg042
Amrein K, Sourij H, Wagner G, Holl A, Pieber TR, Smolle KH, et al. Short-term effects of high-dose oral vitamin D3 in critically ill vitamin D deficient patients: a randomized, double-blind, placebo-controlled pilot study. Crit Care. 2011;15(2):R104. doi: 10.1186/cc10120
Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, et al. Vitamin D supplementation for pre- vention of mortality in adults. Cochrane Database Syst Rev. 2011;(7):CD007470. doi: 10.1002/14651858.CD007470. pub2
Amrein K, Schnedl C, Holl A, Riedl R, Christopher KB, Pachler C, et al. Effect of high-dose vitamin D3 on hospital length of stay in critically ill patients with vitamin D defi- ciency: the VITdAL-ICU randomized clinical trial. JAMA. 2014;312(15):1520-30. doi: 10.1001/jama.2014.13204
Blay B, Thomas S, Coffey R, Jones L, Murphy CV. Low vita- min D level on admission for burn injury is associated with increased length of stay. J Burn Care Res. 2017;38(1):8-13. doi: 10.1097/BCR.0000000000000445
Langlois PL, Szwec C, D’Aragon F, Heyland DK, Manzanares W. Vitamin D supplementation in the critically ill: a systema- tic review and meta-analysis. Clin Nutr. 2018;37(4):1238-46. doi: 10.1016/j.clnu.2017.05.006
Amrein K, Parekh D, Westphal S, Preiser JC, Berghold A, Riedl R, et al. Effect of high-dose vitamin D3 on 28-day mortality in adult critically ill patients with severe vitamin D deficiency: a study protocol of a multicentre, placebo-controlled double- blind phase III RCT (the VITDALIZE study). BMJ Open. 2019;9(11):e031083. doi: 10.1136/bmjopen-2019-031083
Hardy G, Hardy I, Manzanares W. Selenium supplementation in the critically ill. Nutr Clin Pract. 2013;27(1):21-33. doi: 10.1177/0884533611434116
Andrews PJ. Selenium and glutamine supplements: where are we heading? A critical care perspective. Curr Opin Clin Nutr Metab Care. 2010;13(2):192-7. doi: 10.1097/ MCO.0b013e32833617cd
Burk RF. Selenium, an antioxidant nutrient. Nutr Clin Care. 2002;5(2):75-9. doi: 10.1046/j.1523-5408.2002.00006.x
Forceville X, Mostert V, Pierantoni A, Vitoux D, Le Toumelin P, Plouvier E, et al. Selenoprotein P, rather than glutathione peroxidase, as a potential marker of septic shock and rela- ted syndromes. Eur Surg Res. 2009;43(4):338-47. doi: 10.1159/000239763
Marín Martínez AM. Guía de soporte metabólico y nutri- cional-UCI adultos. Epidemiólogos asociados; 2014. doi: 10.13140/2.1.3641.3767
Duncan A, Dean P, Simm M, O’Reilly D, Kinsella J. Zinc supplementation in intensive care: results of a UK Survey. J Crit Care. 2012;27(1):102.e1-e6. doi: 10.1016/j.jcrc.2011.07.083
Caldis-Coutris N, Gawaziuk JP, Logsetty S. Zinc supplemen- tation in burn patients. J Burn Care Res. 2012;33(5):678-82. doi: 10.1097/BCR.0b013e31824799a3
Fessler TA. Trace elements in parenteral nutrition: a practical guide for dosage and monitoring for adult patients. Nutr Clin Pract. 2013;28(6):722-9. doi: 10.1177/0884533613506596
Cabezas-Agrícola JM. Protocolo diagnóstico de la hipocalce- mia. Programa de Formación Médica Continuada Acreditado. 2004;9(17):1080-2. doi: 10.1016/S0211-3449(04)70163-0
Jiménez-Yupandii HP. Comparación entre el calcio sérico total corregido para la albúmina y el calcio iónico en el diagnóstico de hipocalcemia en pacientes ancianos hospitalizados [Tesis doctoral]. Perú: USMP; 2015.
Melchers M, van Zanten A, Raymond H. Management of hypocalcaemia in the critically ill. Curr Opin Crit Care. 2023;29(4):330-8. doi: 10.1097/MCC.0000000000001059
Berger MM. Vitamin C requirements in parenteral nutrition. Gastroenterology. 2009;137(5):70-8. doi: 10.1053/j.gas- tro.2009.08.012
Oudemans-van Straaten HM, Spoelstra-de Man AM, de Waard MC. Vitamin C revisited. Crit Care. 2014;18(4):460. doi: 10.1186/s13054-014-0460-x
Long CL, Maull KI, Krishnan RS, et al. Ascorbic acid dynamics in the seriously ill and injured. J Surg Res. 2003;109(2):144-8. doi: 10.1016/s0022-4804(02)00083-5
Egi M, Ogura H, Yatabe T, Atagi K, Inoune S, Iba T, et al. The japanese clinical practice guidelines for management of sep- sis and septic shock 2020 (J-SSCG 2020). J Intensive Care. 2022;10(1):50. doi: 10.1186/s40560-022-00641-4
McClave SA, Beth ET, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN. 2016;40(2):159-211. doi: 10.1177/0148607115621863
Singer P, Blaser AR, Berger MM, Calder PC, Casaer M, Hiesmayr M, et al. ESPEN practical and partially revised gui- deline: Clinical nutrition in the intensive care unit. Clinic Nut. 2023;42(9):1671-89. doi: 10.1016/j.clnu.2023.07.011
Bartels M, Biesalski HK, Engelhart K, Sendlhofer G, Rehak P, Nagel E. Pilot study on the effect of parenteral vitamin E on ischemia and reperfusion induced liver injury: a dou- ble blind, randomized, placebo-controlled trial. Clin Nutr. 2004;23(6):1360-70. doi: 10.1016/j.clnu.2004.05.003
Traber MG, Atkinson J. Vitamin E, antioxidant and nothing more. Free Radic Biol Med. 2007;43(1):4-15. doi: 10.1016/j. freeradbiomed.2007.03.024
Corcoran TB, O’Neill MP, Webb SA, Ho KM. Inflammation, vitamin deficiencies and organ failure in critically ill patients. Anaesth Intensive Care. 2009;37(5):740-7. doi: 10.1177/0310057X0903700510
Thompson MA, Zuniga K, Sousse L, Christy R, Gurney CJ. The role of vitamin E in thermal burn injuries, infection, and sepsis: a review. J Burn Care Res. 2022;43(6):1260-70. doi: 10.1093/jbcr/irac100
Christopher KB. Vitamin D supplementation in the ICU patient. Curr Opin Clin Nutr Metab Care. 2015;18(2):187- 92. doi: 10.1097/MCO.0000000000000147
Amrein K, Martucci G, McNally JD. When not to use meta- analysis: Analysing the meta-analyses on vitamin D in cri- tical care. Clin Nutr. 2017;36(6):1729-30. doi: 10.1016/j. clnu.2017.08.009
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Judit Perales Pascual, Ana López Pérez, Maria López Pérez
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
