Jpen Parenter Enter
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Jpen Parenter Enter · Sep 2008
Review Meta AnalysisZinc supplementation in critically ill patients: a key pharmaconutrient?
The purpose of the present paper is to provide a rationale for zinc supplementation as a potential therapeutic agent in critically ill patients by describing its role in health and disease, conducting a systematic review of current randomized trials in critical care, considering optimum route and dose of administration, and making recommendations for future research. Normal zinc homeostasis is required for a functional immune system, adequate antioxidant capacity, glucose homeostasis, and wound healing. In addition, zinc is a required cofactor for many enzymes, transcription factors, and replication factors. ⋯ Thus, because of the paucity of clinical data, there is inadequate evidence to recommend the routine use of high-dose zinc supplementation in the critically ill. A first step would be to determine the optimal dose that has a maximal positive effect on underlying inflammatory, immunologic, and metabolic processes yet is safe and tolerated by critically ill patients. Subsequently, large, rigorously designed, randomized trials are required to elucidate the efficacy of such doses of zinc supplementation in this patient population.
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Infants and children are susceptible to the profound metabolic effects of critical illness. In addition, preexisting malnutrition and obesity have adverse consequences during the intensive care unit stay. Early enteral and parenteral feeding can improve nutrition deficits, but neither has been sufficiently studied to show an effect on clinical outcomes in pediatric critical care. Indirect calorimetry is a useful technique that identifies patients receiving inadequate or excessive nutrition, but this technique is underused.