Positive Health Online

Abstract

STOPPE and COLLEAGUES, (1)University Hospital Wuerzburg, Department of Anaesthesiology, Intensive Care,  Emergency and Pain Medicine, Würzburg, Germany; (2)Department of Cardiac Anesthesiology and Intensive Care Medicine, German  Heart Center Charité Berlin, Berlin, Germany; (3)Department of Intensive Care, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands. Conducted a narrative review and critical discussion about recent clinical trials which evaluated the clinical significance of a vitamin C, vitamin D, or selenium administration in critically ill patients.

Background

Methodology

Recent large-scale randomized controlled trials (RCTs) challenged current beliefs about the potential role of micronutrients to attenuate the inflammatory response and improve clinical outcomes of critically ill patients. The purpose of this narrative review is to provide an overview and critical discussion about most recent clinical trials, which evaluated the clinical significance of a vitamin C, vitamin D, or selenium administration in critically ill patients.

Results

RESULTS:  None of the most recent large-scale RCTs could demonstrate any clinical benefits for a micronutrient administration in ICU patients, whereas a recent RCT indicated harmful effects, if high dose vitamin C was administered in septic patients. Following meta-analyses could not confirm harmful effects for high dose vitamin C in general critically ill patients and indicated benefits in the subgroup of general ICU patients with higher mortality risk. For vitamin D, the most recent large-scale RCT could not demonstrate clinical benefits for critically ill patients, whereas another large-scale RCT is still ongoing. The aggregated and meta-analyzed evidence highlighted a potential role for intravenous vitamin D administration, which encourages further research. In high-risk cardiac surgery patients, a perioperative application of high-dose selenium was unable to improve patients' outcome. The observed increase of selenium levels in the patients' blood did not translate into an increase of antioxidative or anti-inflammatory enzymes, which illuminates the urgent need for more research to identify potential confounding factors.

Conclusion

Current data received from most recent large-scale RCTs could not demonstrate clinically meaningful effects of an intervention with either vitamin C, vitamin D, or selenium in critically ill patients. More attention is needed to carefully identify potential confounding factors and to better evaluate the role of timing, duration, and combined strategies. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

References

Stoppe C(1)(2), Dresen E(1), de Man A(3). Micronutrients as therapy in critical illness.  Curr Opin Crit Care. ;30(2):178-185. doi:  10.1097/MCC.0000000000001133. Epub 2024 Jan 5. Apr 1 2024.