Selenium, as Sodium Selenite, in the Treatment of Septic Shock

• Weaning time of catecholamines
  

• - 6 month mortality rate
  
• - 6 month quality of life
  
• - 28 days mortality
  
• - ICU mortality
  
• - Hospital mortality
  
• - ICU length of stay
  
• - Hospital length of stay
  
• - Number of nosocomial infections in ICU
  
• - Duration of ventilation
  
• - SOFA score in ICU at days 4, 7, 10 and 14
  
• - Oxidative stress evaluation at days 4, 7, 10 and 14
  
• - Inflammation evaluation at days 4, 7, 10 and 14
  
• - Selenium status
  
• - Costs and work load
  
• - Onset of clinical events
  

Septic shock - an uncontrolled systemic host response to invasive infection -, leading to multiple organ failure, is a public health issue because of its frequency (> 1/1000 inhabitants per year), its cost and its 45% mortality rate, remaining high despite all the improvements made in ICU for the past 20 years. His physiopathology is better understood with increasing data supporting the key role of free radicals, and a more than 40% plasma selenium concentration decrease that maybe associated with increased morbidity and mortality. Meanwhile, for the past 30 years, researches have been conducted on the essential trace element selenium for its requirement for key antioxidant enzymes, through the 21st aa selenocystein, and also for its potentially toxic, pro-oxidant properties. In septic shock, both properties may be useful, antioxidant enzymatic to increase cell defense especially endothelial cells, and direct pro-oxidant action to decrease the genomic response, especially on phagocytic cells.

The objective of this study is to evaluate the effects of a high dose of selenium administration, such as selenite, at pro-oxydant initial dose followed by anti-oxidant dose in severe septic shock patients with documented infection. The initial dose was chosen as the highest dose of selenium, as sodium selenite, estimated without severe adverse effects in healthy people for a one-day ingestion. The patients are randomized to receive either the placebo or the selenite at this high initial dose followed by lower doses on a 9-day period. The efficacy will be evaluated by the weaning time of catecholamines, with a special attention to the 6-month mortality rate as first secondary end point.