Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral
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Selenium is an essential micronutrient for humans. Critically ill patients with Systemic Inflammatory Response Syndrome (SIRS) and Multiple Organ Dysfunction (MOD) -such as severe sepsis, trauma, severe pancreatitis and critical burns- are exposed to severe oxidative stress. These patients exhibit decreased serum Selenium and selenoenzymes like Glutathione Peroxidase and Selenoprotein P. ⋯ However, no clinical trials using Selenium supplementation in high doses have yet demonstrated significant improvement in mortality. The aims of this review are to evaluate: a) Selenium metabolism, b) the role of selenoenzymes during critical illness, c) clinical studies using Selenium alone or in combination with other antioxidants in critically ill patients and d) to analyze current parenteral Selenium replacement strategies and their results. Further multicentre, well designed randomized, double blind clinical trials about Selenium supplementation in critically ill patients with SIRS and MODS are required and appear to be attractive, necessary and challenging.
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The use of enteral nutrition (EN) in the critically-ill patient makes necessary to evaluate its effectiveness and impact on achieving the target requirements. Gastrically administered EN has a high complication rate, especially increased residue that leads to hyponutrition. The use of the small bowel (jejunum) may achieve greater administered volume, although there are three aspects that directly influence on its use: intestinal access route, motility and absorptive capability, and barrier function. ⋯ Among the hypothesis trying to explain systemic infection and multiorgan failure (MOF), there is precisely anatomical and functional integrity of the intestinal mucosa. Mucosal impairment with increased IP has been shown in burn patients, polytrauma, major surgery, hematopoietic cell transplantation, and sepsis, although its relationship with bacterial translocation has not clearly been established. Before the evidences that link the GIT with MOF, the monitoring methods aimed at early correction of splaenic hypoperfusion focus on the mechanisms implicated in increased IP.