05 Nov 06
Reduction of nosocomial pneumonia after major burns by trace element supplementation
By MM Berger, P Eggimann, DK Heyland, RL Chiolero, J-P Revelly, A Day, W Raffoul and A Shenkin
Nosocomial pneumonia is a major source of morbidity and mortality after severe burns. Burned patients suffer trace element deficiencies, depressed antioxidant and immune defences. The study aimed at determining the effect of trace element supplementation on nosocomial or ICU-acquired pneumonia.
Material and methods
Two consecutive, randomised double-blinded, supplementation studies including two homogeneous groups of 41 severely burned patients (20 placebo and 21intervention) admitted to the Burn centre of a University hospital were combined. Intervention: intravenous trace element supplements (copper 2.5-3.1 mg/d, selenium 315-380 mcg/d, zinc 26.2-31.4 mg/d) for 8 to 21 days versus placebo. Endpoints were infections during the first 30 days (predefined criteria for pneumonia, bacteremia, wound, urine, other), wound healing, length of ICU stay. Plasma and skin (study 2) concentrations of Se and Zn were determined on days 3, 10 and 20.
Results
The patients, aged 42+/-15 years were burned on 46+/-19% of body surface: the combined characteristics of the patients did not differ between the groups. Plasma trace element concentrations and antioxidative capacity were significantly enhanced with normalization of plasma selenium, zinc and glutathione peroxidase concentrations in plasma and skin in the trace element supplemented group. A significant reduction in number of infections was observed in the supplemented patients, which decreased from 3.5+/-1.2 to 2.0+/-1.0 episodes per patient in placebo group (p <0.001). This was related to a reduction of nosocomial pneumonia, which occurred in 16 (80%) patients versus 7 (33%) patients respectively (p<0.001), and of ventilator-associated pneumonia from 13 to 6 episodes respectively (p=0.023).
Conclusions
Enhancing trace element status and antioxidant defences by selenium, zinc and copper supplementation was associated with a decrease of nosocomial pneumonia in critically ill severely burned patients.