Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Herlev Acute, Critical and Emergency Care Science Unit (Herlev-ACES), Herlev and Gentofte University Hospital, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2020 Jan;64(1):131-136. doi: 10.1111/aas.13468. Epub 2019 Oct 13.
Depletion of the trace elements magnesium, phosphate and zinc is common in patients admitted to the intensive care unit (ICU). Observational studies have suggested worse outcome in patients with hypomagnesaemia, hypophosphataemia or hypozincaemia, but also inverse associations with worse outcome with too high serum levels. However, it is unclear whether data from randomised clinical trials (RCTs) confirm this. Accordingly, we plan to assess the balance between benefits and harms of supplementation as compared with placebo or no supplementation in adult ICU patients.
We will conduct a systematic review of RCTs with meta-analysis and trial sequential analysis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions, the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement and the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach. We will assess the effects of any supplementation with magnesium, phosphate or zinc vs. placebo or no treatment in adult ICU patients. We will systematically search the Cochrane CENTRAL, Embase, PubMed, and for unpublished trials: ClinicalTrials.gov, the EU clinical Trials Register and the WHO International Clinical Trials Registry Platform. The primary outcomes will be days alive without mechanical ventilation and overall mortality. Secondary outcomes include use for mechanical ventilation, tachy-arrhythmias, use of vasopressors, length of hospital stay and use of renal replacement therapy.
The benefits and harms of supplementation therapy with magnesium, phosphate and zinc in general ICU patients are unknown. This outlined systematic review will provide data on the evidence, on which future recommendations for supplementation may be founded.
在入住重症监护病房（ICU）的患者中，微量元素镁、磷酸盐和锌的消耗很常见。观察性研究表明，低镁血症、低磷酸盐血症或低锌血症患者的预后较差，但血清水平过高也与预后较差呈负相关。然而，尚不清楚随机临床试验（RCT）的数据是否证实了这一点。因此，我们计划评估补充剂与安慰剂或不补充相比，在成年 ICU 患者中的益处和危害之间的平衡。
我们将按照 Cochrane 干预措施系统评价手册、系统评价和荟萃分析的首选报告项目（PRISMA）声明以及推荐评估、制定与评价（GRADE）方法，对 RCT 进行系统评价和荟萃分析，并进行试验序贯分析。我们将评估任何补充镁、磷酸盐或锌与安慰剂或不治疗相比，在成年 ICU 患者中的效果。我们将系统地搜索 Cochrane 中央、Embase、PubMed，并针对未发表的试验：ClinicalTrials.gov、欧盟临床试验注册处和世界卫生组织国际临床试验注册平台。主要结局指标将是无机械通气存活天数和总死亡率。次要结局指标包括机械通气使用、心动过速性心律失常、血管加压素使用、住院时间和肾脏替代治疗的使用。
补充镁、磷酸盐和锌在一般 ICU 患者中的治疗效果和安全性尚不清楚。本系统评价将提供有关证据的数据，为未来的补充建议提供依据。
