Michelle Phan

Abstract
Andrews PJ, Avenell A, Noble DW, Campbell MK, Croal BL, Simpson WG, Vale LD, Battison
CG, Jenkinson DJ, Cook JA. Randomised trial of glutamine, selenium, or both, to supplement
parenteral nutrition for critically ill patients. BMJ 2011;342:d1542.
Recent methodical reviews have that suggested the parenteral administration of glutamine and/or
selenium reduces mortality and the risk of new infections. However, many of these reviews were
of poor quality based on small samples and had a variety of concerns. The purpose of this study
was to conduct a large randomized sample to determine whether the addition of glutamine,
selenium, or both in a standard preparation of parenteral nutrition influenced the rate of new
infections and mortality among critically ill patients.

The double blind study was conducted in Scotland on 502 adults that were aged 16 years or
older. The patients had to be in level 2 and 3 intensive care and high dependency units for at least
48 hours, with gastrointestinal failure and required at least 50% of their nutritional requirements
from parenteral nutrition. Patients were randomly selected to one of four treatments through a
remote telephone computer system. Treatment A was the parenteral nutrition bag that contained
the standard preparation of 12.5 g nitrogen, 2000kcal. Treatment B contained the standard
formula plus 20.2 g glutamine. Treatment C comprised of the standard formula and 500 g
selenium. Treatment D contained treatment B with an addition of 500 g selenium. Additional
parenteral nitrogen and energy were not allowed to be added to the bags, however standard
additions of fluid, electrolytes, vitamins, and minerals were allowed. The intervention lasted a
maximum of seven days.

Both Treatments B and C had not significantly affected patients rate of developing a new
infection, however patients that received Treatment C for over five days had a beneficial effect.
Treatment D also showed no statistically significant effect. The six-month mortality rate was not
significantly different for both Treatments B and C. However, the mortality rate for Treatment B
was slightly higher than Treatment A. Those in Treatment C had the lowest six-month mortality
rate. The interaction between the glutamine and selenium in Treatment D was not significant.

The authors concluded that those with a critical illness might benefit from an administration of
parenteral nutrition supplemented by 500 g selenium daily for at least five days. Although this
study showed that the additional selenium might reduce the risk of new infection, further
research should either provide confirmation or a rebuttal.

Comment: The study showed that the addition of selenium to parenteral nutrition could be
beneficial, while glutamine was not. Although it may have been difficult to conduct, the patients
should have received the different treatments for the same amount of time. The majority of the
patients were also already receiving antibiotics and a few had received enteral or parenteral
nutrition prior to the intervention, this couldve changed the influence that the selenium and
glutamine had on the patients.