were blinded to treatment allocation. Consent procedures
followed the 2003 Mental Health (Care and
Treatment, Scotland) Act. Ethical approval was
obtained from the Multicentre Research Ethics Committee
Scotland.
Interventions
The daily trial interventions were parenteral nutrition
bag containing (a) standard formulation (12.5 g nitrogen,
2000 kcal), (b) glutamine formulation (12.5 g nitrogen
(including 20.2 g glutamine), 2000 kcal),
(c) standard formulation with addition of 500 μg selenium,
(d) glutamine formulation with addition of 500
μg selenium. Both standard and glutamine formulations
were tested for long term stability in parenteral
nutrition bags (1500 ml volume), and for short term
stability after addition of selenium. Selenium was
added by the hospital pharmacy aseptic unit. Standard
additions of fluid, electrolytes, vitamins, and minerals
(including low dose selenium, ≤50 μg daily) were
allowed. Additional parenteral nitrogen or energy
were not allowed to be added to the bags (to retain
the isonitrogenous nature of the interventions).
Trial intervention was for a maximum of seven days
(on critical care units and subsequently on hospital
wards). Trial parenteral nutrition was started as soon
as practicable with the pharmacy. For men weighing
<60 kg and women weighing <70 kg the volume
of feed could be reduced to reflect reduced
requirements.5
Measures of outcome
The primary outcomes were numbers of participants
with new infections in the first 14 days after randomisation
and mortality (on critical care unit, and overall at
six months). Infections were defined in two ways: (a) all
clinically suspected infections (primary definition) and
(b) only infections confirmed in accordance with the
Centers for Disease Control criteria (after review by
the adjudication committee).
Other outcome measures defined a priori were
length of stay on critical care unit, length of stay in
acute hospital, days of antibiotic use (assessed during
the 14 days after starting the trial intervention), modified
Sequential Organ Failure Assessment (SOFA)
score assessed over seven days (central nervous system
domain removed as most patients were sedated in the
critical care units and some were admitted after head
injury), and serious adverse events for 14 days (excluding
deaths). It was not possible to collect data on ventilator
use.5
Quality of life measures (SF-12 andEQ-5Dquestionnaires)
were collected at three and six months by post,
but will be presented in a separate paper with the economic
evaluation.
Information on deaths after discharge was obtained
from routine data collected by the Information Services
Division of the Scottish National Health Service.
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