Parenteral glutamine supplementation in critical illness: a systematic review

Abstract

IntroductionThe potential benefit of parenteral glutamine (GLN) supplementation has been one of the most commonly studied nutritional interventions in the critical care setting. The aim of this systematic review was to incorporate recent trials of traditional parenteral GLN supplementation in critical illness with previously existing data.MethodsAll randomized controlled trials of parenterally administered GLN in critically ill patients conducted from 1997 to 2013 were identified. Studies of enteral GLN only or combined enteral/parenteral GLN were excluded. Methodological quality of studies was scored and data was abstracted by independent reviewers.ResultsA total of 26 studies involving 2,484 patients examining only parenteral GLN supplementation of nutrition support were identified in ICU patients. Parenteral GLN supplementation was associated with a trend towards a reduction of overall mortality (relative risk (RR) 0.88, 95% confidence interval (CI) 0.75, 1.03, P = 0.10) and a significant reduction in hospital mortality (RR 0.68, 95% CI 0.51, 0.90, P = 0.008). In addition, parenteral GLN was associated with a strong trend towards a reduction in infectious complications (RR 0.86, 95% CI 0.73, 1.02, P = 0.09) and ICU length of stay (LOS) (WMD –1.91, (95% CI -4.10, 0.28, P = 0.09) and significant reduction in hospital LOS (WMD -2.56, 95% CI -4.71, -0.42, P = 0.02). In the subset of studies examining patients receiving parenteral nutrition (PN), parenteral GLN supplementation was associated with a trend towards reduced overall mortality (RR 0.84, 95% CI 0.71, 1.01, P = 0.07).ConclusionsParenteral GLN supplementation given in conjunction with nutrition support continues to be associated with a significant reduction in hospital mortality and hospital LOS. Parenteral GLN supplementation as a component of nutrition support should continue to be considered to improve outcomes in critically ill patients.

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

“…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.…”

“…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).…”

“…Nevertheless, in a meta-analysis of 15 randomized controlled trials including 2,862 patients, Chen QH et al (10) documented a reduction of the nosocomial infections rate with glutamine supplementation in surgical ICU patients. Moreover, in a systematic review of 26 studies involving 2,484 patients, Wischmeyer PE et al (1) observed that parenteral glutamine supplementation of nutrition support in critical illness was associated with a significant reduction in hospital mortality and in hospital length of stay, a strong trend towards a reduction in infectious complications and ICU length of stay, and a trend towards reduction of overall mortality. 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.…”

“…Glutamine is the most abundant non-essential amino acid in the human body and it is considered as a conditionally essential amino acid in stress conditions (1).…”

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“…Glutamine plays a vital role in inducing cellular protection pathways, modulation of the inflammatory response, and prevention of organ injury after illness and/or injury. 19 During the transplant period, oral L-glutamine (500 mg/kg/d) was routinely initiated and it was added to TPN fluid during parenteral nutrition therapy.…”