Antioxidant micronutrients in the critically ill: a systematic review and meta-analysis
Critical Care, 04/26/2012
Manzanares W et al. – Supplementation with high dose trace elements and vitamins may improve outcomes of critically ill patients, particularly those at high risk of death.
The authors searched computerized databases, reference lists of pertinent articles, and personal files from 1980 to 2011.
They included randomized controlled trials (RCTs) conducted in critically ill adults patients that evaluated relevant clinical outcomes with antioxidants micronutrients (vitamins and trace elements) supplementation versus placebo.
A total of 21 RCTs met inclusion criteria.
When the results of these studies were statistically aggregated (n=20), combined antioxidants were associated with a significant reduction in mortality (risk ratio [RR]=0.82, 95% confidence interval [CI] 0.72-0.93, P=0.002); a significant reduction in duration of mechanical ventilation (weighed mean difference in days=-0.67, 95% CI -1.22,-0.13, P=0.02); a trend towards a reduction in infections (RR=0.88, 95% CI 0.76,1.02, P=0.08); and no overall effect on ICU or hospital length of stay (LOS).
Furthermore, antioxidants were associated with a significant reduction in overall mortality among patients with higher risk of death (>10% mortality in control group) (RR 0.79, 95 % CI 0.68, 0.92, P=0.003) whereas there was no significant effect observed for trials of patients with a lower mortality in the control group (RR=1.14, 95% 0.72, 1.82, P=0.57).
Trials using more than 500g per day of selenium showed a trend towards a lower mortality (RR=0.80, 95% CI 0.63-1.02, P=0.07) whereas trials using doses lower than 500g had no effect on mortality (RR 0.94, 95% CI 0.67-1.33, P=0.75).
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