Enteral Glutamine Supplementation in Critically Ill Patients with Burn Injuries: A Retrospective Case‐Control Evaluation

Juang, Paul; Fish, Douglas N.; Jung, Rose; MacLaren, Robert

doi:10.1592/phco.27.1.11

Cited by 19 publications

(21 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Muscle proteolysis in response to trauma/hemorrhagic shock is known to promote the release of free amino acids for catabolic purposes (27,37), as we here observe in response to shock, but not in shams. If plasma amino acid accumulation in response to hemorrhagic shock would be dependent in proteolysis alone, fold-change increases in amino acid levels should be proportional to their abundance in proteins.…”

Section: Discussionsupporting

confidence: 52%

“…Thus, it is worth noting that glutamine levels increased to a lesser extent compared with other amino acids only upon hemorrhagic shock, albeit not in sham animals, suggesting ongoing glutaminolysis in response to hemorrhage/ hemorrhagic shock. Enteral supplementation of glutamine is one nutritional concept for severely injured patients in recent years (27,37). Additionally, glutamine exerts an important nutritional effect serving as a principle fuel source for enterocytes and intestinal mucosa (24).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Early hemorrhage triggers metabolic responses that build up during prolonged shock

D’Alessandro

Moore

et al. 2015

American Journal of Physiology-Regulatory, Integrative and Comp

View full text Add to dashboard Cite

-Metabolic staging after trauma/hemorrhagic shock is a key driver of acidosis and directly relates to hypothermia and coagulopathy. Metabolic responses to trauma/hemorrhagic shock have been assayed through classic biochemical approaches or NMR, thereby lacking a comprehensive overview of the dynamic metabolic changes occurring after shock. Sprague-Dawley rats underwent progressive hemorrhage and shock. Baseline and postshock blood was collected, and late hyperfibrinolysis was assessed (LY30 Ͼ3%) in all of the tested rats. Extreme and intermediate time points were collected to assay the dynamic changes of the plasma metabolome via ultra-high performance liquid chromatography-mass spectrometry. Sham controls were used to determine whether metabolic changes could be primarily attributable to anesthesia and supine positioning. Early hemorrhage-triggered metabolic changes that built up progressively and became significant during sustained hemorrhagic shock. Metabolic phenotypes either resulted in immediate hypercatabolism, or late hypercatabolism, preceded by metabolic deregulation during early hemorrhage in a subset of rats. Hemorrhagic shock consistently promoted hyperglycemia, glycolysis, Krebs cycle, fatty acid, amino acid, and nitrogen metabolism (urate and polyamines), and impaired redox homeostasis. Early dynamic changes of the plasma metabolome are triggered by hemorrhage in rats. Future studies will determine whether metabolic subphenotypes observed in rats might be consistently observed in humans and pave the way for tailored resuscitative strategies. hemorrhagic shock; mass spectrometry; metabolomics; plasma; trauma DESPITE DECADES OF ADVANCES in prehospital care, trauma remains the leading cause of death for individuals under the age of 40 (36). As much as 40% of injury-related mortality is attributed to uncontrollable hemorrhage (36), which in both civilian and military settings is the leading preventable cause of death after injury (40). Conspicuous factors associated with early mortality in trauma patients include trauma-induced coagulopathy, hypothermia, and metabolic acidosis, a series of mechanisms referred to as the "bloody vicious cycle" and later renamed as the "lethal triad" (14). These concepts laid the foundation for "damage control surgery", an approach aimed at minimizing operating time as to control sources of significant bleeding and gastrointestinal contamination, while prioritizing early management of coagulopathy, hypothermia, and metabolic acidosis (46).Early descriptions of metabolic responses to trauma were documented by Cuthbertson, who characterized two distinct phases: the "ebb" and the "flow" (9). The former corresponds to an early hypometabolic state that may serve a protective role aimed at reducing posttraumatic energy depletion. The latter is accompanied by an increased metabolic rate (including increased energy expenditure and oxygen consumption) (14,18,24,29). Other overlapping stages have been described over the years, such as the "ischemia-reperfusion," "leukocytic," and ...

show abstract

Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Early hemorrhage triggers metabolic responses that build up during prolonged shock

D’Alessandro

Moore

et al. 2015

American Journal of Physiology-Regulatory, Integrative and Comp

View full text Add to dashboard Cite

show abstract

“…The addition of Gln to standard enteral feeds or to an immunomodulatory formula did not improve survival in intensive care unit patients (Hall et al 2003, Schulman et al 2005. In a retrospective case-control study, enteral glutamine supplementation was not associated with a change in the cumulative rate of infectious complications in burn intensive care patients (Juang et al 2007). In a prospective study developed in a surgical trauma intensive care unit, there were no differences among the groups receiving enteral glutamine supplementation or standard feedings related to the acquisition of lung infections (Schulman et al 2006) (Table I).…”

Section: Clinical Studiesmentioning

confidence: 94%

“…However, clinical efficacy of glutamine supplementation was not demonstrated in some reports (Hall et al 2003, Schulman et al 2005, Juang et al 2007), probably because of the heterogeneous patients populations studied, the use of different doses of glutamine, and the lack of a predictable physiologic end-point for glutamine supplementation previously identified in animals studies. Additionally, factors related to the clinical management need to be taken into account.…”

Section: Clinical Studiesmentioning

confidence: 99%

“…Although the guidelines about enteral/parenteral nutrition recommend the enteral route to delivery immunonutrients, so far there have not been sufficient data to support enteral glutamine supplementation in surgical or critically ill patients (Schulman et al 2005, Juang et al 2007). The addition of Gln to standard enteral feeds or to an immunomodulatory formula did not improve survival in intensive care unit patients (Hall et al 2003, Schulman et al 2005.…”

Section: Clinical Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Understanding the mechanisms of glutamine action in critically ill patients

Oliveira

Dias

Pelosi

et al. 2010

An. Acad. Bras. Ciênc.

View full text Add to dashboard Cite

Glutamine (Gln) is an important energy source and has been used as a supplementary energy substrate. Furthermore, Gln is an essential component for numerous metabolic functions, including acid-base homeostasis, gluconeogenesis, nitrogen transport and synthesis of proteins and nucleic acids. Therefore, glutamine plays a significant role in cell homeostasis and organ metabolism. This article aims to review the mechanisms of glutamine action during severe illnesses. In critically ill patients, the increase in mortality was associated with a decreased plasma Gln concentration. During catabolic stress, Gln consumption rate exceeds the supply, and both plasma and skeletal muscle pools of free Gln are severely reduced. The dose and route of Gln administration clearly influence its effectiveness: high-dose parenteral appears to be more beneficial than low-dose enteral administration. Experimental studies reported that Gln may protect cells, tissues, and whole organisms from stress and injury through the following mechanisms: attenuation of NF (nuclear factor)-κB activation, a balance between pro-and anti-inflammatory cytokines, reduction in neutrophil accumulation, improvement in intestinal integrity and immune cell function, and enhanced of heat shock protein expression. In conclusion, high-doses of parenteral Gln (>0.50 g/kg/day) demonstrate a greater potential to benefit in critically ill patients, although Gln pathophysiological mechanisms requires elucidation.

show abstract

Immunonutrition as an adjuvant therapy for burns

Tan

Danilla

Murray

et al. 2014

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Although we found evidence of an effect of glutamine on mortality reduction, this finding should be taken with care. The number of study participants analysed in this systematic review was not sufficient to permit conclusions that recommend or refute the use of glutamine. Glutamine may be effective in reducing mortality, but larger studies are needed to determine the overall effects of glutamine and other immunonutrition agents.

show abstract

Enteral Glutamine Supplementation in Critically Ill Patients with Burn Injuries: A Retrospective Case‐Control Evaluation

Cited by 19 publications

References 42 publications

Early hemorrhage triggers metabolic responses that build up during prolonged shock

Early hemorrhage triggers metabolic responses that build up during prolonged shock

Understanding the mechanisms of glutamine action in critically ill patients

Immunonutrition as an adjuvant therapy for burns

Contact Info

Product

Resources

About