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Selenium pharmaconutrition in sepsis: To give or not to give? Is this still the question?

机译：败血症中的硒药物：给与不给？这仍然是问题吗？

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The Surviving Sepsis Campaign (SSC) International Guidelines for Management of Severe Sepsis and Septic Shock [1] were recently updated to assist critical care practitioners in managing the proliferation of emerging evidence for the treatment of sepsis syndromes and improving the prognosis of sepsis. Regarding pharmaconutrition with high-dose intravenous (IV) selenium, we find it surprising that these new SSC guidelines suggest, "not using intravenous selenium for the treatment of severe sepsis (grade 2C)" [1]. We respectfully disagree with this recommendation and question the rationale for this conclusion. In our opinion, the SSC may not have considered much of the published clinical evidence. In fairness, the author's recommendation does not exclude the use of low-dose selenium in parenteral nutrition (PN) but no reference is made to the American Society for Parenteral and Enteral Nutrition (ASPEN) position paper on micronutrients [2] indicating that, although controversial, "patients who are deficient in selenium or who are critically ill, septic, or have severe burns may benefit from short term very high daily doses [of selenium] administered separately from the PN" [2].
机译：最近更新了《生存脓毒症运动（SSC）国际严重脓毒症和脓毒性休克管理指南》 [1]，以帮助重症监护从业人员管理新兴证据的扩散，以治疗脓毒症综合征和改善脓毒症的预后。关于大剂量静脉内（IV）硒的药物营养，我们发现这些新的SSC指南提出了令人惊讶的建议：“不使用静脉内硒治疗严重脓毒症（2C级）” [1]。我们尊重这一建议，并对这一结论的理由提出质疑。我们认为，SSC可能没有考虑很多已发表的临床证据。公平地讲，作者的建议并不排除在肠胃外营养（PN）中使用低剂量硒，但未提及美国肠外和肠内营养协会（ASPEN）关于微量营养素的立场文件[2]，尽管有争议的是，“缺乏硒的患者，重病，脓毒性或严重烧伤的患者，可从PN中单独使用短期每日高剂量[硒]，从而受益” [2]。

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