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Diet and Nutrition in Critical Care pp 445–458Cite as

Micronutrient Supplementation for Critically Ill Adults: Practical Application

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Abstract

Critical illness is associated with oxidative stress and low levels of most micronutrients, with resultant compromised antioxidant defenses. Micronutrient supplementation is thought to be beneficial to critically ill patients by ameliorating oxidative stress and by improving clinical outcomes. The current evidence base suggests potential benefit of micronutrient (specifically antioxidant) supplementation in critically ill adults in terms of defined clinical outcomes (notably a decrease in mortality, shorter mechanical ventilation, and possibly a reduction in infectious complications). A combination of supplemental vitamins and trace elements (including selenium) should be considered in critically ill patients. The current evidence suggests that timing (as early as possible), sufficient duration, and dosing are key factors to ensure optimal clinical benefit. Micronutrients should be provided at, at least, the current available recommended doses to prevent clinical deficiencies. For further possible benefit, clinicians should consult the guidelines from professional nutrition societies and the higher micronutrient dosages as employed in the various trials (in the clinical settings studied). Furthermore, clinicians will be well served by keeping the bigger picture in mind, within the settings of the complexity of the acute phase response and the heterogeneity of the critical care population. In this fast-evolving field, the definition of optimal nutrition therapy should include all relevant components (including micronutrients) in the right combination and doses, to the right patients, and at the right time to ensure optimal clinical benefit and outcome.

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Abbreviations

APR:

Acute phase response

EN:

Enteral

ICU:

Intensive care unit

IL:

Interleukin

IV:

Intravenous

LICU:

Length of ICU stay

LOS:

Length of hospital stay

NF-kB:

Nuclear factor-kappa B

PN:

Parenteral

RCT:

Randomized controlled trial

ROS:

Reactive oxygen species

SIRS:

Systemic inflammatory response syndrome

TNF-α:

Tumor necrosis factor alpha

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Authors and Affiliations

  1. Division of Human Nutrition, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, 19063, 7505, Tygerberg, South Africa

    Janicke Visser & Renée Blaauw

Authors
  1. Janicke Visser
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  2. Renée Blaauw
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Corresponding author

Correspondence to Janicke Visser .

Editor information

Editors and Affiliations

  1. Royal Free London Hospitals, Barnet General Hospital, London, UK

    Rajkumar Rajendram

  2. Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Rajkumar Rajendram

  3. King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia

    Rajkumar Rajendram

  4. Department of Nutrition and Dietetics, Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Victor R. Preedy

  5. Department of Biomedical Sciences, Faculty of Science & Technology, University of Westminster, London, UK

    Vinood B. Patel

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Visser, J., Blaauw, R. (2015). Micronutrient Supplementation for Critically Ill Adults: Practical Application. In: Rajendram, R., Preedy, V.R., Patel, V.B. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7836-2_78

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  • DOI: https://doi.org/10.1007/978-1-4614-7836-2_78

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-7837-9

  • Online ISBN: 978-1-4614-7836-2

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