A prospective randomized trial of enteral glutamine in critical illness

Hall, John C.; Dobb, Geoffrey; Hall, Joanne M.; Sousa, Ruth de; Brennan, Lisa; Mccauley, Rosalie

doi:10.1007/s00134-003-1937-2

Cited by 114 publications

(60 citation statements)

References 35 publications

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“…Lower-dose glutamine Brantley & Pierce (12) Déchelotte et al (15) Fuentes-Orozco et al (18) Griffiths et al (21) Hall et al (22) Jones et al (25) Kumar et al (27) Luo et al (28) Ockenga et al (33) Perez-Barcena et al (36) Sahin et al (38) Tjäder et al (41) Wischmeyer et al (42) Subtotal ( (P=0·11) 14 1 2 2 11 4 0 10 47 32 22 21 72 41 10 59 304 9 6 5 10 21 3 2 4 37 31 22 24 72 39 10 64 299 1·32 0·13 0·34 0·15 0·44 1·30 0·16 3·06 0·66 0·50, 3·51 0·02, 1·19 0·06, 1·98 0·03, 0·78 0·19, 0·99 0·27, 6·21 0·01, 3·85 0·90, Categorisation into critical illness or surgical trials was difficult. Trials in which participants had pancreatitis or surgery followed by complications, e.g.…”

Section: Discussionmentioning

confidence: 99%

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Symposium 4: Hot topics in parenteral nutrition Current evidence and ongoing trials on the use of glutamine in critically-ill patients and patients undergoing surgery

Avenell

2009

Proc. Nutr. Soc.

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The amino acid glutamine has numerous important roles including particularly antioxidant defence, immune function, the inflammatory response, acid–base balance and N economy. The present systematic review of randomised controlled trials of nutrition support with glutamine up to August 2008 has found that parenteral glutamine in critical illness is associated with a non-significant reduction in mortality (risk ratio 0·71 (95% CI 0·49, 1·03)) and may reduce infections. However, poor study quality and the possibility of publication bias mean that these results should be interpreted with caution. There is no evidence to suggest that glutamine is harmful in terms of organ failure and parenteral glutamine may reduce the development of organ failure.

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Section: Discussionmentioning

confidence: 99%

“…Critical illness EN Conejero et al (13) Garrel et al (19) Hall et al (22) Houdijk et al (23) Kumar et al (27) Schulman et al (39) Subtotal (95 % CI)…”

Section: Methodsmentioning

confidence: 99%

Symposium 4: Hot topics in parenteral nutrition Current evidence and ongoing trials on the use of glutamine in critically-ill patients and patients undergoing surgery

Avenell

2009

Proc. Nutr. Soc.

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“…A number of laboratory studies have confirmed the gut-protective effects of enteral glutamine administered to the postischemic gut (26,38). Additionally, clinical studies have demonstrated that enteral glutamine administered to trauma, burn, and critically ill patients decreases morbidity in most but not all studies (3,17,19,23,42,64). We have shown that the early use of glutamine during active shock resuscitation is safe (37).…”

Section: Discussionmentioning

confidence: 72%

Glutamine protects against apoptosis via downregulation of Sp3 in intestinal epithelial cells

Ban

Kozar

2010

American Journal of Physiology-Gastrointestinal and Liver Physi

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Glutamine plays a key role in intestinal growth and maintenance of gut function, and as we have shown protects the postischemic gut (Kozar RA, Scultz SG, Bick RJ, Poindexter BJ, Desoigne R, Weisbrodt NW, Haber MM, Moore FA. Shock 21: 433–437, 2004). However, the precise mechanisms of the gut protective effects of glutamine have not been well elucidated. In the present study, RNA microarray was performed to obtain differentially expressed genes in intestinal epithelial IEC-6 cells following either 2 mM or 10 mM glutamine. The result demonstrated that specificity protein 3 (Sp3) mRNA expression was downregulated 3.1-fold. PCR and Western blot confirmed that Sp3 expression was decreased by glutamine in a time- and dose-dependent fashion. To investigate the role of Sp3, Sp3 gene siRNA silencing was performed and apoptosis was assessed. Silencing of Sp3 demonstrated a significant increase in Bcl-2 and decrease in Bax protein expression, as well as a decrease in caspase-3, -8, and -9 protein expression and activity. The protein expression of apoptosis-related proteins after hypoxia/reoxygenation was similar to that of normoxia and correlated with a decrease in DNA fragmentation. Importantly, the addition of glutamine to Sp3-silenced cells did not further lessen apoptosis, suggesting that Sp3 plays a major role in the inhibitory effect of glutamine on apoptosis. This novel finding may explain in part the gut-protective effects of glutamine.

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“…[33] Researchers believe that Gln is potentially 'life-saving' in critical illness, particularly when it is administered at a parenteral dose of over 0.3 g/kg per day. [34][35][36] In conclusion, parenteral Gln administration can up-regulate serum HSP-70 concentration, decrease the levels of AST, ALT,TbiL, TNF-α, and IL-6, shorten the length of mechanical ventilation and ICU stay, and improve the ratio of CD4/CD8 in critical patients with acute liver injury. The correlation between Gln and HSP70 found in this study suggests that early parenteral glutamine administration could improve outcomes of critical patients with acute liver injury by increasing the expression of heat shock protein..…”

Section: Discussionmentioning

confidence: 87%

Protective effect of glutamine in critical patients with acute liver injury

Ni¹,

Zheng²,

Qin³

2011

World Journal of Emergency Medicine

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A prospective randomized trial of enteral glutamine in critical illness

Abstract: This clinical trial did not support the use of enteral glutamine supplements in similar cohorts of critically ill patients.

Cited by 114 publications

References 35 publications

Symposium 4: Hot topics in parenteral nutrition Current evidence and ongoing trials on the use of glutamine in critically-ill patients and patients undergoing surgery

Symposium 4: Hot topics in parenteral nutrition Current evidence and ongoing trials on the use of glutamine in critically-ill patients and patients undergoing surgery

Glutamine protects against apoptosis via downregulation of Sp3 in intestinal epithelial cells

Protective effect of glutamine in critical patients with acute liver injury

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