Glutamine administration reduces Gram-negative bacteremia in severely burned patients: A prospective, randomized, double-blind trial versus isonitrogenous control

Wischmeyer, Paul E.; Lynch, James C.; Liedel, Jennifer L.; Wolfson, Rachel L.; Riehm, Jacob J.; Gottlieb, Lawrence J.; Kahana, Madelyn

doi:10.1097/00003246-200111000-00006

Cited by 292 publications

(176 citation statements)

References 17 publications

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“…Several controlled trials in specific subgroups of postsurgical and other types of patients have shown beneficial clinical or metabolic effects when GLN is added to PN. 25,[31][32][33][34][35]39,41,42 These studies have incorporated L-GLN doses in PN ranging from 0.29 to 0.57 g/kg/d, 25,[31][32][33][34][35]39 and alanyl-GLN dipeptide doses similar to the dose used in the current trial (0.40-0.50 g/kg/d or equivalent to 0.26-0.33 g of L-GLN/kg/d). However, several trials also show no benefits, possibly attributable to differences in study patient clinical characteristics and degree of GLN depletion within and between studies, as well as the dose of parenteral GLN used.…”

Section: Discussionmentioning

confidence: 99%

“…Our infection data are consistent with previous studies showing a beneficial effect of GLN-supplemented PN to decrease nosocomial infections in other types of critically ill patients. 31,[39][40][41][42] S aureus is responsible for a high percentage of nosocomial infections in postsurgical and ICU patients. [1][2][3][4][5] Our data show for the first time that GLN-supplemented PN specifically reduces infections attributed to S aureus, fungi, and enteric Gram-negative bacteria, which were markedly decreased with GLN-PN in the nonpancreatic surgery cohort ( Table 4).…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of Parenteral Nutrition Supplemented With Glutamine Dipeptide to Decrease Hospital Infections in Critically Ill Surgical Patients

Estívariz

Griffith

Luo

et al. 2008

J Parenter Enteral Nutr

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Background-Nosocomial infections are an important cause of morbidity and mortality in the surgical intensive care unit (SICU). Clinical benefits of glutamine-supplemented parenteral nutrition may occur in hospitalized surgical patients, but efficacy data in different surgical subgroups are lacking. The objective was to determine whether glutamine-supplemented parenteral nutrition differentially affects nosocomial infection rates in selected subgroups of SICU patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy of Parenteral Nutrition Supplemented With Glutamine Dipeptide to Decrease Hospital Infections in Critically Ill Surgical Patients

Estívariz

Griffith

Luo

et al. 2008

J Parenter Enteral Nutr

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“…Critical illness PN de Beaux et al (14) Déchelotte et al (15) Estivariz et al (16) Fuentes-Orozco et al (18) Fuentes-Orozco et al (17) Griffiths et al (21) Ockenga et al (33) Perez-Barcena et al (36) Sahin et al (38) Wischmeyer et al (42) Subtotal (95 % CI) Total events: 104 (treatment), 136 (control) Test for heterogeneity: χ 2 12·9, df 9 (P=0·17), I 2 30·4 % Test for overall effect: Z 2·24 (P=0·03)…”

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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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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“…One study in patients with burns (Wischmeyer et al 2001) has used parenteral glutamine independently of the method of feed administration with good effect on infectious complications. This approach to parenteral administration independent of the route of feeding appears very promising and needs testing in a wider critical-care setting.…”

Section: Glutamine and Its Effect On Heat-shock Proteinsmentioning

confidence: 99%

Nutritional interventions in critical illness

Powell-Tuck

2007

Proc. Nutr. Soc.

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The metabolism of critical illness is characterised by a combination of starvation and stress. There is increased production of cortisol, catecholamines, glucagon and growth hormone and increased insulin-like growth factor-binding protein-1. Phagocytic, epithelial and endothelial cells elaborate reactive oxygen and nitrogen species, chemokines, pro-inflammatory cytokines and lipid mediators, and antioxidant depletion ensues. There is hyperglycaemia, hyperinsulinaemia, hyperlactataemia, increased gluconeogenesis and decreased glycogen production. Insulin resistance, particularly in relation to the liver, is marked. The purpose of nutritional support is primarily to save life and secondarily to speed recovery by reducing neuropathy and maintaining muscle mass and function. There is debate about the optimal timing of nutritional support for the patient in the intensive care unit. It is generally agreed that the enteral route is preferable if possible, but the dangers of the parenteral route, a route of feeding that remains important in the context of critical illness, may have been over-emphasised. Control of hyperglycaemia is beneficial, and avoidance of overfeeding is emphasised. Growth hormone is harmful. The refeeding syndrome needs to be considered, although it has been little studied in the context of critical illness. Achieving energy balance may not be necessary in the early stages of critical illness, particularly in patients who are overweight or obese. Protein turnover is increased and N balance is often negative in the face of normal nutrient intake; optimal N intakes are the subject of some debate. Supplementation of particular amino acids able to support or regulate the immune response, such as glutamine, may have a role not only for their potential metabolic effect but also for their potential antioxidant role. Doubt remains in relation to arginine supplementation. High-dose mineral and vitamin antioxidant therapy may have a place.

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Glutamine administration reduces Gram-negative bacteremia in severely burned patients: A prospective, randomized, double-blind trial versus isonitrogenous control

Cited by 292 publications

References 17 publications

Efficacy of Parenteral Nutrition Supplemented With Glutamine Dipeptide to Decrease Hospital Infections in Critically Ill Surgical Patients

Efficacy of Parenteral Nutrition Supplemented With Glutamine Dipeptide to Decrease Hospital Infections in Critically Ill Surgical Patients

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

Nutritional interventions in critical illness

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