High-Protein Enteral Nutrition Enriched With Immune-Modulating Nutrients vs Standard High-Protein Enteral Nutrition and Nosocomial Infections in the ICU

Abstract

trialregister.nl Identifier: NTR2181.

Glutaminemia prognostic significance in critical surgical patients – An analysis of plasma aminogram profile; Significado pronóstico de la glutaminemia en pacientes quirúrgicos críticos - Análisis del perfil del aminograma plasmático

“…In the present study, prevalence of severe hypoglutaminemia in surgical critical patients at the admission in the ICU was high and mean glutaminemia values were similar to those described by Van Zanten et al (12). A significant moderate positive correlation was demonstrated between admission glutaminemia and severity score SAPS II, contrary to the previous studies (2).…”

“…Analysis of the results is also hampered by differences in the glutamine administration schedule: dosage (0.2 to 0.8 g/kg/day), route of delivery (intravenous, enteral or combined), timing (in the acute phase or later), duration and type of provision (nutritional supplementation or pharmacotherapy independent of nutritional support) (1,6,11,12,28,29). Furthermore, in previously published trials, glutamine plasma concentration was not routinely measured at the time of study enrollment (1,7,11,12,28,29).…”

“…Severe glutamine depletion in critically ill patients, with plasma levels under 420 µmol/l, has been considered as a pejorative prognostic factor (2,3) and has demonstrated a variable prevalence, described between 25 and 67% (1,12,30,31). In addition, high baseline plasma concentrations of glutamine have been also associated with increased mortality rate.…”

“…Considering the high variability of glutaminemia at admission in ICU (1,12,30,31), the potential benefits of supplementation on glutamine-depleted patients (1,(8)(9)(10) and the risks of the glutamine administration in cases with high plasma concentration (2,11), A. Glutaminemia profile in hospital surviving (n = 21) and non-surviving (n = 7) surgical critically ill patients at the moment of admission in the intensive care unit (ICU), at the first and third days, and in historical reference healthy subjects (23) (n = 11). Comparisons were performed with the Student's-t test (with reference group) and paired Student's-t test (between the ICU moments of evaluation).…”

“…More recently, Van Zanten ARH et al (8) verified, in a systematic review and meta-analysis of 11 studies including 1,079 adult critically ill patients, that enteral glutamine supplementation was associated with a significant decrease in hospital length of stay (with no effect on hospital mortality, infections complications or length of stay in ICU), and a significant reduction in hospital mortality in burned patients. However, two of the most recent large multicenter randomized controlled studies, the Redoxs and MetaPlus trials, suggested that glutamine supplementation was associated with increased long-term mortality (particularly in medical patients) (11,12).…”