Selenium plays an indispensable role in antioxidant defense through its incorporation into selenoproteins, including glutathione peroxidase (GPx) and thioredoxin reductase. In the context of trauma and critical illness, systemic inflammation and oxidative stress frequently deplete selenium reserves, compromising the body’s antioxidant defenses. This deficiency exacerbates immune dysfunction, elevates the risk of multi-organ dysfunction syndrome, and increases susceptibility to infections and mortality. Observational studies have consistently shown that lower selenium levels correlate with poorer clinical outcomes, such as extended stays in intensive care units and higher mortality rates. Supplementation of selenium has demonstrated promise in restoring GPx activity, reducing oxidative stress markers, and supporting recovery, particularly in patients with pre-existing selenium deficiency. While the impact on mortality remains variable across clinical trials, early and targeted supplementation appears to be beneficial, especially when combined with other micronutrients like vitamins C and E or zinc. These combinations enhance the antioxidant response and tackle the complex oxidative pathways in critically ill and trauma patients. Importantly, the clinical benefits of selenium supplementation appear to be influenced by baseline selenium status, with patients exhibiting severe deficiency deriving the most pronounced improvements in oxidative stress markers, immune function, and recovery. This review highlights the critical importance of addressing selenium deficiency, advocating for personalized therapeutic strategies. However, further large-scale studies are essential to optimize dosing regimens, refine combination therapies, and validate selenium’s therapeutic potential in trauma and critical care settings.

The mortality rate of patients with hemodynamic instability due to severe pelvic fracture is reported to be 40–60 % despite a multidisciplinary treatment approach. Angioembolization and external fixation of the pelvis are the main procedures used to control bleeding in these patients. Several studies have shown that preperitoneal pelvic packing (PPP) is effective for hemorrhage control, despite being small and observational in nature. The purpose of this study was to describe a Korean trauma center’s early experience with PPP in unstable patients with pelvic fractures and to evaluate its effectiveness. Between January 2012 and May 2015, 30 patients with hemodynamic instability caused by pelvic fracture were enrolled in this study. PPP has been performed in 14 patients since May 2014. Data of pelvic fracture patients with hemodynamic instability were selected from Wonju Severance Christian Hospital Pelvic Trauma Database and were analyzed retrospectively. Mean age and mean ISS were 60.4 ± 18.8 years and 39.2 ± 8.1 in 30 unstable patients with pelvic fracture. Mean SBP was 89.1 ± 24.7 mmHg, and mean hemoglobin was 10.6 ± 2.3 g/dL. When the non-PPP group (16 patients) and the PPP group (14 patients) were compared, there was no significant difference in the age, gender, ISS, and occurrence of associated injury (p = 0.82, p = 0.23, p = 0.92, and p = 0.60, respectively). Mortality rate due to acute hemorrhage were 37.5 % in the non-PPP group and 14.3 % in the PPP group. In the PPP group, three patients underwent PPP in the hybrid operating room, and a laparotomy was performed in three patients. Mean systolic blood pressure increased significantly after PPP (71.6 ± 9.8 vs. 132.2 ± 36.4 mmHg, p = 0.002). In unstable patients with pelvic fractures, PPP can be used as an effective treatment, complementary to AE, to control pelvic bleeding.

Early postoperative enteral feeding has been demonstrated to improve the outcome of patients who underwent surgery for gastrointestinal (GI) malignancies, trauma, perforation, and/or obstruction. Thus, this study was conducted to assess the efficacy of early postoperative enteral nutrition (EN) after emergency surgery in patients with GI perforation or strangulation. The medical records of 484 patients, admitted between January 2007 and December 2012, were reviewed retrospectively. Patients were divided into 2 groups: the early EN (EEN, N = 77) group and the late EN (LEN, N = 407) group. The morbidity, mortality, length of hospital, and intensive care unit (ICU) stays were compared between the 2 groups. Propensity score matching was performed in order to adjust for any baseline differences. Patients receiving EEN had reduced in-hospital mortality rates (EEN 4.5% vs LEN 19.4%; P = 0.008), pulmonary complications (EEN 4.5% vs LEN 19.4%; P = 0.008), lengths of hospital stay (median: 14.0, interquartile range: 8.0–24.0 vs median: 17.0, interquartile range: 11.0–26.0, P = 0.048), and more 28-day ICU-free days (median: 27.0, interquartile range: 25.0–27.0 vs median: 25.0, interquartile range: 22.0–27.0, P = 0.042) than those receiving LEN in an analysis using propensity score matching. The significant difference in survival between the 2 groups was also shown in the Kaplan–Meier survival curve (P = 0.042). In a further analysis using the Cox proportional hazard ratio after matching on the propensity score, EEN was associated with reduced in-hospital mortality (hazard ratio, 0.03; 95% confidence interval, 0.01–0.49; P = 0.015). EEN is associated with beneficial effects, such as reduced in-hospital mortality rates, pulmonary complications, lengths of hospital stay, and more 28-day ICU-free days, after emergency GI surgery.

Traumatic pancreatic injuries are rare and present diagnostic and therapeutic difficulties. We evaluated the usefulness of endoscopic retrograde pancreatography and transpapillary pancreatic stent in the diagnosis and treatment of pancreatic trauma patients. We reviewed medical records of 83 pancreas trauma patients who underwent endoscopic retrograde pancreatography for the suspicion of pancreas duct injury between January 1983 and December 2016. Patient notes, radiologic findings, laboratory investigations, operative records, and endoscopic retrograde pancreatography reports were reviewed. Pre-endoscopic retrograde pancreatography abdominal computed tomography was performed in 52 patients. Twenty-seven patients of them were diagnosed with a major pancreatic duct injury by subsequent endoscopic retrograde pancreatography. Eleven major pancreatic duct injuries (40.7%) were missed by the pre-endoscopic retrograde pancreatography abdominal CT. Major pancreatic duct injury was confirmed by endoscopic retrograde pancreatography in 43 patients. These 43 major pancreatic duct injury patients were classified into the Operative (n = 21), Stent (n = 15), and Conservative (n = 7) groups according to the first treatment modality which was chosen by attending surgeon. Age, initial white blood cell count, initial serum amylase, associated injury, and major pancreatic duct injury site were similar among groups, while the rate of parenchymal leakage (Dye leakage confined to pancreatic capsule) on endoscopic retrograde pancreatography findings differed. Parenchymal leakage was most common in the Conservative group. Pancreas related mortality occurred in 1 (4.76%) Operative group, 2 (13.33%) Stent group, and 0 (0%) Conservative group. Pancreas related complication occurred in 16 (76.19%) Operative group, 10 (66.67%), Stent group and 5 (71.43%) Conservative group. There were no statistically significant differences in the occurrence rate of pancreas related complications and mortalities among three groups. Endoscopic retrograde pancreatography helps clinicians choose a treatment modality for major pancreatic duct injury since it provides information about the precise condition of the major pancreatic duct injury. Endoscopic retrograde pancreatography with transpapillary pancreatic stenting also shows promise as a substitute for laparotomy or pancreatic resection in selected patients.