The effectiveness of trace element supplementation following severe burn injury: a systematic review

Abstract

Trace elements have an important physiological role following severe burn injury with patients routinely receiving supplementation. Although trace element supplementation is commonly prescribed after burn injury, variations exist between supplement composition, frequency and the dosage administered. This objective of this research was to identify, assess and synthesise the available evidence on the effectiveness of trace element supplementation on clinically meaningful outcomes, including mortality, length of stay, rate of wound healing and complications in patients who have sustained a severe burn injury. Following development of an a priori protocol, the effectiveness of selenium, copper and zinc supplementation, either alone or combined, compared to placebo or standard treatment, was investigated via systematic review and meta-analysis. A comprehensive search strategy was designed and employed to identify published and unpublished research. Methodological quality of eligible studies was critically appraised and relevant data extracted for synthesis. Eight studies were included in the review: four randomised controlled trials and four nonrandomised experimental trials, representing 398 participants with an age range of six to 67 years. Results of this research indicate that the use of parentally-administered combined trace elements following burn injury confers positive effects in decreasing infectious complications. Combined parenteral trace element supplementation and combined oral and parenteral zinc supplementation have potentially clinically significant implications on reducing length of stay. Oral zinc supplementation shows possible beneficial effects on mortality. Further studies are required to accurately define optimal trace element supplementation regimens, dosages and routes, and to determine cost-effectiveness.