Résumé
La dysfonction viscérale associée au sepsis est l’une des causes majeures de décès en unité de soins intensifs (USI). Le stress oxydatif semble un élément clé de sa pathophysiologie. Ainsi, différentes thérapies de support, dont l’apport de micronutriments antioxydants, ont été développées au cours des dernières décennies afin d’améliorer la survie des patients septiques. Selon la littérature, la supplémentation en sélénium (Se) devrait être considérée comme la pierre angulaire du traitement par antioxydants du patient critique. Elle ne doit toutefois pas qu’être considérée comme une simple stratégie de supplémentation. En effet, l’acide sélénieux (H2SeO3) et le sélénite de sodium (Na2SeO3), particulièrement pentahydraté (5H2O-Na2SeO3), administrés en bolus intraveineux à haute dose, devraient être considérés comme un traitement oxydant et cytotoxique, comportant un risque tératogène et carcinogène. Des études animales seraient nécessaires pour mieux en définir le mécanisme d’action et la toxicité induite. La pharmacocinétique, la durée de traitement et la toxicité à long terme doivent également être approfondies. L’effet duSe administré à haute dose au cours du sepsis doit ainsi être confirmé par de puissants et rigoureux essais cliniques de phase III. L’objectif de cette revue est de discuter la thérapie par Se chez le patient adulte en USI, analysant si son effet est dû à une simple supplémentation ou à une intervention pharmacologique.
Abstract
Sepsis-related organ dysfunction remains a major cause of death in the intensive care unit (ICU). So far, different adjunct therapies including antioxidant micronutrients have been developed to improve survival in septic patients.According to current evidence, selenium therapy should be considered as the cornerstone antioxidant strategy and not only as an antioxidant supplementation in ICU patients. The selenocompounds including selenious acid (H2SeO3) and sodium selenite (Na2SeO3) provided as pentahydrate sodium selenite (5H2O-Na2SeO3) should be considered as drugs with oxidant and cytotoxic effects when a loading dose is administered as intravenous bolus. Teratogenic and carcinogenic risks should also be taken into consideration. Animal studies are still required to define Na2SeO3 mechanisms of action and toxicity. A better understanding of its pharmacokinetic profile, duration of therapy, and long-term toxicity data is required. Additionally, the effect of selenium therapy in sepsis should be assessed in large, well-designed phase III clinical trials. Our purpose is to review selenium therapy in ICU adult patients, investigating whether its effects are related to a simple supplementation or a pharmacological intervention.
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Langlois, P.L., Manzanares, W. & Hardy, G. Thérapie par sélénite de sodium chez le patient aux soins intensifs: supplémentation ou intervention pharmacologique ?. Réanimation 22, 521–530 (2013). https://doi.org/10.1007/s13546-013-0717-4
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DOI: https://doi.org/10.1007/s13546-013-0717-4