Berger Mette M, Eggimann Philippe, Heyland Daren K, Chioléro René L, Revelly Jean-Pierre, Day Andrew, Raffoul Wassim, Shenkin Alan
Department of Adult Intensive Care Medicine & Burn Centre, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
Crit Care. 2006;10(6):R153. doi: 10.1186/cc5084.
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.
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.
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).
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.
医院获得性肺炎是严重烧伤后发病和死亡的主要原因。烧伤患者存在微量元素缺乏以及抗氧化和免疫防御功能低下的情况。本研究旨在确定补充微量元素对医院获得性或重症监护病房（ICU）获得性肺炎的影响。
两项连续的、随机的、双盲的补充研究合并在一起，这两项研究纳入了大学医院烧伤中心收治的两组各41例重度烧伤患者（20例接受安慰剂，21例接受干预）。干预措施为静脉补充微量元素（铜2.5至3.1毫克/天、硒315至380微克/天、锌26.2至31.4毫克/天），持续8至21天，对照组给予安慰剂。观察终点为前30天内的感染情况（肺炎、菌血症、伤口、尿液及其他感染的预定义标准）、伤口愈合情况以及ICU住院时间。在第3天、第10天和第20天测定血浆和皮肤（研究2）中的硒和锌浓度。
患者年龄为42±15岁，体表烧伤面积为46%±19%：两组患者的综合特征无差异。补充微量元素组血浆微量元素浓度和抗氧化能力显著增强，血浆和皮肤中的血浆硒、锌和谷胱甘肽过氧化物酶浓度恢复正常。补充微量元素的患者感染次数显著减少，安慰剂组患者每人感染次数从3.5±1.2次降至2.0±1.0次（p<0.001）。这与医院获得性肺炎的减少有关，分别有16例（80%）和7例（33%）患者发生医院获得性肺炎（p<0.001），呼吸机相关性肺炎分别从13例降至6例（p=0.023）。
通过补充硒、锌和铜提高微量元素水平及抗氧化防御能力与危重症、重度烧伤患者医院获得性肺炎的减少有关。
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