Reduction of Nosocomial Pneumonia After Major Burns by Trace Element Supplementation: Aggregation of Two Randomised Trials

Overview

Journal Crit Care

Specialty Critical Care

Date 2006 Nov 4

PMID 17081282

Citations 22

Authors

Mette M Berger

Philippe Eggimann

Daren K Heyland

Rene L Chiolero

Jean-Pierre Revelly

Andrew Day

Wassim Raffoul

Alan Shenkin

Affiliations

Soon will be listed here.

Abstract

Introduction: Nosocomial pneumonia is a major source of morbidity and mortality after severe burns. Burned patients suffer trace element deficiencies and depressed antioxidant and immune defences. This study aimed at determining the effect of trace element supplementation on nosocomial or intensive care unit (ICU)-acquired pneumonia.

Methods: Two consecutive, randomised, double-blinded, supplementation studies including two homogeneous groups of 41 severely burned patients (20 placebo and 21 intervention) admitted to the burn centre of a university hospital were combined. Intervention consisted of intravenous trace element supplements (copper 2.5 to 3.1 mg/day, selenium 315 to 380 mug/day, and zinc 26.2 to 31.4 mg/day) for 8 to 21 days versus placebo. Endpoints were infections during the first 30 days (predefined criteria for pneumonia, bacteraemia, wound, urine, and other), wound healing, and length of ICU stay. Plasma and skin (study 2) concentrations of selenium and zinc were determined on days 3, 10, and 20.

Results: The patients, 42 +/- 15 years old, were burned on 46% +/- 19% of body surface: the combined characteristics of the patients did not differ between the groups. Plasma trace element concentrations and antioxidative capacity were significantly enhanced with normalisation of plasma selenium, zinc, and glutathione peroxidase concentrations in plasma and skin in the trace element-supplemented group. A significant reduction in number of infections was observed in the supplemented patients, which decreased from 3.5 +/- 1.2 to 2.0 +/- 1.0 episodes per patient in placebo group (p < 0.001). This was related to a reduction of nosocomial pneumonia, which occurred in 16 (80%) patients versus seven (33%) patients, respectively (p < 0.001), and of ventilator-associated pneumonia from 13 to six episodes, respectively (p = 0.023).

Conclusion: Enhancing trace element status and antioxidant defences by selenium, zinc, and copper supplementation was associated with a decrease of nosocomial pneumonia in critically ill, severely burned patients.

Citing Articles

Trace elements: Clinical perspectives in the critically ill.

Karunakaran V, Harding K, Sarnowski A, Walter E J Intensive Care Soc. 2025; :17511437241305269.

PMID: 39926387 PMC: 11800230. DOI: 10.1177/17511437241305269.

Serum Selenium-Binding Protein 1 (SELENBP1) in Burn Injury: A Potential Biomarker of Disease Severity and Clinical Course.

Turan T, Klein H, Hackler J, Hoerner L, Rijntjes E, Graf T Antioxidants (Basel). 2023; 12(11).

PMID: 38001780 PMC: 10669776. DOI: 10.3390/antiox12111927.

Combined copper and zinc deficiency is associated with reduced SARS-CoV-2 immunization response to BNT162b2 vaccination.

Chillon T, Demircan K, Hackler J, Heller R, Kaghazian P, Moghaddam A Heliyon. 2023; 9(10):e20919.

PMID: 37886755 PMC: 10597833. DOI: 10.1016/j.heliyon.2023.e20919.

Role of Selenoproteins in Bacterial Pathogenesis.

Sumner S, Markley R, Kirimanjeswara G Biol Trace Elem Res. 2019; 192(1):69-82.

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Preoperative patient preparation in enhanced recovery pathways.

Iqbal U, Green J, Patel S, Tong Y, Zebrower M, Kaye A J Anaesthesiol Clin Pharmacol. 2019; 35(Suppl 1):S14-S23.

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