Enteral Glutamine During Active Shock Resuscitation Is Safe and Enhances Tolerance of Enteral Feeding

McQuiggan, Margaret M.; Kozar, Rosemary A.; Sailors, R. Matthew; Ahn, Chul; McKinley, Bruce A.; Moore, Frederick A.

doi:10.1177/014860710803200128

Cited by 55 publications

(31 citation statements)

References 39 publications

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“…High-dose glutamine Conejero et al (13) Estivariz et al (16) Fuentes-Orozco et al (17) Garrel et al (19) Goeters et al (20) Houdijk et al (23) McQuiggan et al (29) Schulman et al (39) Subtotal (95 % CI) Total events: 44 (treatment), 60 (control) Test for heterogeneity: χ 2 16·1, df 7 (P=0·02), I 2 56·6 % Test for overall effect: Z 1·90 (P=0·06)…”

Section: Discussionmentioning

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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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%

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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“…This might be due to a relatively well-preserved enteral tolerance in patients with trauma and burns, while in patients with severe sepsis or septic shock, intolerance to enteral route for nutrition provision is a common finding. Moreover, a pilot prospective randomized trial showed improved gastrointestinal tolerance when glutamine was added to enteral nutrition in severe trauma patients during shock resuscitation [36]. …”

Section: When Is Extra Glutamine Necessary and What For?mentioning

confidence: 99%

Have We Enough Glutamine and How Does It Work? A Clinician’s View

Soeters

Grecu²

2011

Ann Nutr Metab

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There is a gap between the scientific basis of the claim that in several disease states glutamine is lacking and the widespread belief that supplementation of glutamine to the nutritional regimen is beneficial in severely ill patients. Glutamine shortage exists when consuming tissues, playing a crucial role in the response to trauma and disease, receive insufficient amounts of glutamine. In these tissues (immune system, wound), glutamine is only partly oxidized but has more specific roles as nontoxic nitrogen carrier, precursor of several crucial metabolites required for cell proliferation and for maintenance of the redox potential, and as osmolyte. In inflammatory states, glutamine concentrations in plasma and tissues are decreased due to many disease-related factors, precluding its use as a reliable indicator of shortage. Isotope studies have yielded equivocal results, precluding their use as a reliable indicator of glutamine shortage or adequacy. The increase in the net release of glutamine from peripheral tissues to central tissues (immune system, liver, spleen, wound) in inflammatory states provides a better basis for the necessity to supplement the organism with extra glutamine in these conditions. Glutamine supplementation was beneficial in a few studies in burn or trauma patients. The clinical benefit of parenteral glutamine supplementation in patients with severe inflammation has been demonstrated more convincingly. The amounts of glutamine supplemented approximate the amounts released by peripheral tissues and utilized by central organs operative in host defense and are therefore in the physiological range.

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“…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). Lastly, the REDOX trial includes enteral glutamine administration to critically ill patients in shock, and preliminary results appear promising (20,21).…”

Section: Discussionmentioning

confidence: 80%

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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Enteral Glutamine During Active Shock Resuscitation Is Safe and Enhances Tolerance of Enteral Feeding

Cited by 55 publications

References 39 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

Have We Enough Glutamine and How Does It Work? A Clinician’s View

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

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