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Background  Selenium (Se) is an essential trace element with antioxidant, anti-inflammatory, and immunomodulatory effects. So far, several randomized clinical trials (RCTs) have demonstrated that parenteral Se may improve clinical outcomes in intensive care unit (ICU) patients. Since publication of our previous systematic review and meta-analysis on antioxidants in the ICU, reports of several trials have been published, including the largest RCT on Se therapy. The purpose of the present systematic review was to update our previous data on intravenous (IV) Se in the critically ill.    Methods  We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. We included RCTs with parallel groups comparing parenteral Se as single or combined therapy with placebo. Potential trials were evaluated according to specific eligibility criteria, and two reviewers abstracted data from original trials in duplicate independently. Overall mortality was the primary outcome; secondary outcomes were infections, ICU length of stay (LOS), hospital LOS, ventilator days, and new renal dysfunction.    Results  A total of 21 RCTs met our inclusion criteria. When the data from these trials were aggregated, IV Se had no effect on mortality (risk ratio [RR] 0.98, 95 % CI 0.90–1.08,  P  = 0.72, heterogeneity  I   2  = 0 %). In addition, when the results of ten trials in which researchers reported on infections were statistically aggregated, there was no significant treatment effect of parenteral Se (RR 0.95, 95 % CI 0.88–1.02,  P  = 0.15,  I   2  = 0 %). There was no positive or negative effect of Se therapy on ICU and hospital LOS, renal function, or ventilator days.    Conclusions  In critically ill patients, IV Se as monotherapy does not improve clinical outcomes.    Electronic supplementary material  The online version of this article (doi:10.1186/s13054-016-1529-5) contains supplementary material, which is available to authorized users.

High-dose intravenous selenium does not improve clinical outcomes in the critically ill: a systematic review and meta-analysis