June 21, 2011

Micronutrient supplementation associated with decreased mortality among the critically ill

A review published in the July, 2011 issue of the journal Nutrition concludes that supplementation with vitamins and trace elements may help reduce the risk of dying in critically ill adults.

In their introduction, Janicke Visser and colleagues remark that micronutrient deficiencies can be the result of poor nutritional status in critically ill patients prior to hospitalization or result from the injury or illness itself. Inflammation caused by injury decreases circulating antioxidants, which can be exacerbated by the loss of bodily fluids. "These states of deficiency can affect various enzymatic functions and biochemical processes, resulting in poor wound healing, organ dysfunction, and altered immune status—all with adverse patient outcomes," the authors note.

For their analysis, the authors selected 18 randomized clinical trials involving parenteral/intravenous or oral supplementation of single or combined micronutrients in critically ill patients, in order to determine the effect of such supplementation on mortality, infectious complications and other end points. The nutrients commonly used in the trials included selenium, alpha-tocopherol, ascorbic acid, zinc and copper in varying doses.

Fourteen trials included in the analysis found a decrease in overall mortality and six indicated a reduction in 28 day mortality in association with micronutrient supplementation. Although no decrease in infectious complications or length of intensive care unit or hospital stay was indicated by the meta-analysis, a 31 percent decrease in mortality was associated with combined supplementation.

"The current evidence does suggest a potential benefit of micronutrient supplementation in critically ill adults in terms of some clinical outcomes," the authors write. "Once more, the conclusion is that there is a need for more large, multicenter, standardized, prospective randomized clinical trials to assess the effects of different types and doses of micronutrient supplementation in selected groups of patients with different types of critical illness, with a few such trials already underway. As more trials become available, it is further recommended that subgroup analyses be undertaken for specific critically ill patient groups to determine if certain homogeneous groups could derive more benefit from micronutrient supplementation at levels higher than those currently recommended."

Trauma and wound healing

Trauma is a stressful event caused by either a mechanical or a chemical injury. Depending on its level, trauma can have serious short-term and long-term consequences. The role of healthy nutrition, both in promoting healing and in avoiding complications associated with trauma, has long been acknowledged in trauma recovery.

The body needs a certain amount of nutrients to maintain a constant, healthy state. This need is determined by the basal metabolic rate. Any external or internal trauma raises the metabolic rate, and greater amounts of oxygen and nutrients are required to supply enough fuel and amino acids for repair and recovery.

Biologically, it is difficult to achieve usual levels of nutrition after major trauma because many important nutrients are channeled into the healing effort. In addition, many trauma patients suffer from altered levels of consciousness, poor appetite, reduced digestive function, compromised blood circulation, and a radical alteration of normal daily routines.

The following vitamins and nutrients may aid the healing process:

• Vitamin A—5000 to 10,000 international units (IU) daily
• Vitamin C—1000 milligrams (mg) daily
• Zinc—50 mg daily
• L-arginine—9000 to 18,000 mg daily
• L-ornithine—1000 mg daily
• Glutamine—1000 to 3000 mg daily
• Bromelain—500 mg daily
• Glucosamine —1500 mg daily
• Aloe — follow label directions
• Curcumin—800 to 1600 mg daily
• Omega-3 fatty acids—1400 mg EPA and 1000 mg DHA daily

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