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Update on antioxidant micronutrients in the critically ill

Manzanares, Williama; Langlois, Pascal L.b; Hardy, Gilc

Current Opinion in Clinical Nutrition & Metabolic Care: November 2013 - Volume 16 - Issue 6 - p 719–725
doi: 10.1097/MCO.0b013e32836599e5
MICRONUTRIENTS: Edited by Gil Hardy and Henry C. Lukaski

Purpose of review To evaluate recent evidence on pharmaconutrition with antioxidant micronutrients, for different populations of adult critically ill patients.

Recent findings Over the last few years, different studies have shown that high-dose trace elements and vitamins, especially parenteral selenium and zinc, may be able to improve relevant clinical outcomes in the most seriously ill patients. High-dose selenite monotherapy reduces mortality, particularly when a pharmacological loading dose is given in the early stage of severe sepsis and septic shock. Notwithstanding, the recently published REducing Deaths due to OXidative Stress study using an antioxidant cocktail and parenteral selenite, in addition to standard enteral nutrition, was unable to show any benefits for patients with multiple organ failure.

Summary There is evidence supporting the concept of pharmaconutrition with high-dose micronutrients. Selenium therapy may be able to decrease infections and reduce mortality in sepsis, but more research is needed to better understand pharmacokinetics, optimal composition, timing, duration, and dose of antioxidant cocktails for the critically ill.

aFaculty of Medicine, UDELAR, Department of Critical Care, Intensive Care Unit, Hospital de Clínicas (University Hospital), Montevideo, Uruguay

bFaculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada

cFaculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

Correspondence to William Manzanares, MD, PhD, Assistant Professor- Department of Critical Care, Intensive Care Unit, Hospital de Clínicas (University Hospital), Faculty of Medicine, Universidad de la República (UDELAR), 14th Floor, Italia Av. Montevideo, 11600, Montevideo, Uruguay. Tel: +598 2 4806180; fax: +598 2 4877213; e-mail:

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins