Effects of magnesium, phosphate, or zinc supplementation in intensive care unit patients-A systematic review and meta-analysis.
critically ill
intensive care unit
magnesium
meta analysis
phosphate
zinc
Journal
Acta anaesthesiologica Scandinavica
ISSN: 1399-6576
Titre abrégé: Acta Anaesthesiol Scand
Pays: England
ID NLM: 0370270
Informations de publication
Date de publication:
03 2023
03 2023
Historique:
revised:
06
12
2022
received:
27
09
2022
accepted:
16
12
2022
pubmed:
24
12
2022
medline:
18
2
2023
entrez:
23
12
2022
Statut:
ppublish
Résumé
Low-serum levels of magnesium, phosphate, and zinc are observed in many intensive care unit (ICU) patients, but clinical equipoise exists regarding supplementation strategies. We aimed to assess the desirable and undesirable effects of supplementation with magnesium, phosphate, or zinc in adult ICU patients. We conducted a systematic review with meta-analysis of randomised clinical trials assessing the effects of supplementation with magnesium, phosphate, or zinc in adult ICU patients. Primary outcomes were mortality and duration of mechanical ventilation. We registered the protocol, followed the Preferred Reporting Items for Systematic Review and Meta-Analysis statement, used the Cochrane risk of bias 2 tool, and the grading of recommendations, assessment, development and evaluation (GRADE) approach for assessing the certainty of the evidence. We identified no low risk of bias trials. For magnesium supplementation, we included three trials (n = 235); the relative risk (RR) for mortality was 0.54, 95% confidence interval (CI) 0.30-0.96 compared to no supplementation (very low certainty of evidence). For zinc supplementation, two trials were included (n = 168); the RR for mortality was 0.73, 95% CI 0.41-1.28 compared to control. No trials assessed the effects of phosphate supplementation on mortality. For outcomes other than mortality, only zero or one trial was available. In adult ICU patients, the certainty of evidence for the effects of supplementation with magnesium, phosphate, or zinc was very low. High-quality trials are needed to assess the value of supplementation strategies in these patients.
Sections du résumé
BACKGROUND
Low-serum levels of magnesium, phosphate, and zinc are observed in many intensive care unit (ICU) patients, but clinical equipoise exists regarding supplementation strategies. We aimed to assess the desirable and undesirable effects of supplementation with magnesium, phosphate, or zinc in adult ICU patients.
METHODS
We conducted a systematic review with meta-analysis of randomised clinical trials assessing the effects of supplementation with magnesium, phosphate, or zinc in adult ICU patients. Primary outcomes were mortality and duration of mechanical ventilation. We registered the protocol, followed the Preferred Reporting Items for Systematic Review and Meta-Analysis statement, used the Cochrane risk of bias 2 tool, and the grading of recommendations, assessment, development and evaluation (GRADE) approach for assessing the certainty of the evidence.
RESULTS
We identified no low risk of bias trials. For magnesium supplementation, we included three trials (n = 235); the relative risk (RR) for mortality was 0.54, 95% confidence interval (CI) 0.30-0.96 compared to no supplementation (very low certainty of evidence). For zinc supplementation, two trials were included (n = 168); the RR for mortality was 0.73, 95% CI 0.41-1.28 compared to control. No trials assessed the effects of phosphate supplementation on mortality. For outcomes other than mortality, only zero or one trial was available.
CONCLUSIONS
In adult ICU patients, the certainty of evidence for the effects of supplementation with magnesium, phosphate, or zinc was very low. High-quality trials are needed to assess the value of supplementation strategies in these patients.
Substances chimiques
Magnesium
I38ZP9992A
Zinc
J41CSQ7QDS
Phosphates
0
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
264-276Subventions
Organisme : Research foundation of Rigshospitalet
Organisme : Copenhagen University Hospital
Informations de copyright
© 2022 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.
Références
Geerse DA, Bindels AJ, Kuiper MA, Roos AN, Spronk PE, Schultz MJ. Treatment of hypophosphatemia in the intensive care unit: a review. Crit Care. 2010;14:R147.
Koekkoek WA, van Zanten AR. Antioxidant vitamins and trace elements in critical illness. Nutr Clinic Prac Off Publ Am Soc Parent Enteral Nutr. 2016;31:457-474.
Limaye CS, Londhey VA, Nadkart MY, Borges NE. Hypomagnesemia in critically ill medical patients. J Assoc Physicians India. 2011;59:19-22.
Diringer M. Neurologic manifestations of major electrolyte abnormalities. Handb Clin Neurol. 2017;141:705-713.
Marino PL. Magnesium and phosphorus. The ICU Book. 3rd ed. Lippincott Williams & Wilkins; 2007:647-653.
Vesterlund GK, Ostermann M, Myatra SN, et al. Preferences for the measurement and supplementation of magnesium, phosphate and zinc in ICUs: the international WhyTrace survey. Acta Anaesthesiol Scand. 2021;65:390-396.
DASAIM. Ernaering til kritisk syge. http://www.dasaim.dk/wp-content/uploads/2019/05/NBV-Ern%C3%A6ring-til-kritisk-syge-2019.pdf 2019.
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Cochrane, 2021. Available from www.training.cochrane.org/handbook.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
Granholm A, Alhazzani W, Møller MH. Use of the GRADE approach in systematic reviews and guidelines. Br J Anaesth. 2019;123:554-559.
Schünemann. H BJ, Guyatt G, Oxman A. GRADE handbook for grading quality of evidence and strength of recommendations. The GRADE Working Group. 2013. guidelinedevelopment.org/handbook.
Vesterlund GK, Thomsen T, Møller MH, Perner A. Effects of magnesium, phosphate and zinc supplementation in ICU patients-protocol for a systematic review. Acta Anaesthesiol Scand. 2020;64:131-136.
Julian PT Higgins, Jelena Savovic, Jonathan AC Sterne. Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) (2019) https://sites.google.com/site/riskofbiastool/welcome/rob-2-0-tool/current-version-of-rob-2.
Jakobsen JC, Wetterslev J, Winkel P, Lange T, Gluud C. Thresholds for statistical and clinical significance in systematic reviews with meta-analytic methods. BMC Med Res Methodol. 2014;14:120.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557-560.
Khazdouz M, Mazidi M, Ehsaei MR, Ferns G, Kengne AP, Norouzy AR. Impact of zinc supplementation on the clinical outcomes of patients with severe head trauma: a double-blind randomized clinical trial. J Diet Suppl. 2018;15:1-10.
Sterne JA, Sutton AJ, Ioannidis JP, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011;343:d4002.
Hamill-Ruth RJ, McGory R. Magnesium repletion and its effect on potassium homeostasis in critically ill adults: results of a double-blind, randomized, controlled trial. Crit Care Med. 1996;24:38-45.
Heidary Z, Khalili H, Mohammadi M, Beigmohammadi MT, Abdollahi A. Effect of magnesium loading dose on insulin resistance in patients with stress-induced hyperglycemia: a randomized clinical trial. J Intensive Care Med. 2020;35:687-693.
Barbosa EB, Tomasi CD, de Castro DD, et al. Effects of magnesium supplementation on the incidence of acute kidney injury in critically ill patients presenting with hypomagnesemia. Intensive Care Med. 2016;42:1084-1085.
Hebert P, Mehta N, Wang J, Hindmarsh T, Jones G, Cardinal P. Functional magnesium deficiency in critically ill patients identified using a magnesium-loading test. Crit Care Med. 1997;25:749-755.
Noormandi A, Khalili H, Mohammadi M, Abdollahi A. Effect of magnesium supplementation on lactate clearance in critically ill patients with severe sepsis: a randomized clinical trial. Eur J Clin Pharmacol. 2020;76:175-184.
Pigon J, Lindholm M, Eklund J, Hagelbäck A. Phosphate supplementation in parenteral nutrition. Acta Anaesthesiol Scand. 1985;29:50-54.
Vasiliu I, Mirea L, Balanescu A, Grintescu I. Phosphate supplementation in critical long term mechanically ventilated patients increases ventilator free days. Clinic Nutr. 2012;7:251.
Young B, Ott L, Kasarskis E, et al. Zinc supplementation is associated with improved neurologic recovery rate and visceral protein levels of patients with severe closed head injury. J Neurotrauma. 1996;13:25-34.
Abd-Elsalam S, Soliman S, Esmail ES, et al. Do zinc supplements enhance the clinical efficacy of hydroxychloroquine?: a randomized. Multicenter Trial Biol Trace Elem Res. 2021;199:3642-3646.
Patel O, Chinni V, El-Khoury J, et al. A pilot double-blind safety and feasibility randomized controlled trial of high-dose intravenous zinc in hospitalized COVID-19 patients. J Med Virol. 2021;93:3261-3267.
Lyons MWH, Blackshaw WJ. Does magnesium sulfate have a role in the management of severe traumatic brain injury in civilian and military populations? A systematic review and meta-analysis. J R Army Med Corps. 2018;164:442-449.
Fairley JL, Zhang L, Glassford NJ, Bellomo R. Magnesium status and magnesium therapy in cardiac surgery: a systematic review and meta-analysis focusing on arrhythmia prevention. J Crit Care. 2017;42:69-77.
Arsenault KA, Yusuf AM, Crystal E, et al. Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery. Cochrane Database Syst Rev. 2013;2021:2013 (1) (no pagination).
Yarad EA, Hammond NE. Intravenous magnesium therapy in adult patients with an aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis. Aust Crit Care Off J Confed Aust Crit Care Nurses. 2013;26:105-117.
Rodrigo C, Samarakoon L, Fernando SD, Rajapakse S. A meta-analysis of magnesium for tetanus. Anaesthesia. 2012;67:1370-1374.
Fairley J, Glassford NJ, Zhang L, Bellomo R. Magnesium status and magnesium therapy in critically ill patients: a systematic review. J Crit Care. 2015;30:1349-1358.
Blaser RA, Gunst J, Ichai C, et al. Hypophosphatemia in critically ill adults and children - a systematic review. Clin Nutr. 2021;40:1744-1754.
Hu T, Cheng K, Kuo L. Impact of zinc supplementation on the clinical outcomes in critically ill patients: a systematic review and meta-analysis. Am J Respir Crit Care Med. 2019;199:199.
Gudivada KK, Kumar A, Sriram K, et al. Antioxidant micronutrient supplements for adult critically ill patients: a bayesian multiple treatment comparisons meta-analysis. Clinic Nutr ESPEN. 2022;47:78-88.
Weisinger JR, Bellorín-Font E. Magnesium and phosphorus. Lancet (British Edition). 1998;352:391-396.
Berger MM, Shenkin A, Schweinlin A, et al. ESPEN micronutrient guideline. Clin Nutr. 2022;41:1357-1424.
Noronha JL, Matuschak GM. Magnesium in critical illness: metabolism, assessment, and treatment. Intensive Care Med. 2002;28:667-679.
Pizzol FD, Universidade do Extremo Sul Catarinense - Unidade Academica de Ciecias da. Magnesium Replacement Therapy to Prevent Acute Renal Failure in Critically Ill Patients. https://ClinicalTrials.gov/show/NCT01700998, 2014.
Khalili H. Effect of magnesium on stress-induced hyperglycemia. https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT201611013449N22 2016.
Khalili H. Effect of magnesium sulfate on blood infection. https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT20180410039254N1 2018.
Khazdouz M. Effect of zinc supplementation on severe head trauma patients. https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT2016053028176N1 2016.