The Clinical Role of Glutamine Supplementation in Patients with Multiple Trauma: A Narrative Review

Abstract

Glutamine is considered an essential amino acid during stress and critical illness. Parenteral glutamine supplementation in critically ill patients has been shown to improve survival rate and minimise infectious complications, costs and hospital length-of-stay. However, glutamine supplementation in patients receiving enteral nutrition and the best method of administration are still controversial. The purpose of this article is to provide a narrative review of the current evidence and trials of enteral and parenteral glutamine supplementation in multiple trauma patients. A search in PubMed and EMBASE was conducted and relevant papers that investigated the effect of enteral or parenteral glutamine supplementation in patients with multiple trauma were reviewed. Although recent nutritional guidelines recommend that glutamine supplementation should be considered in these patients, further well-designed trials are required to provide a confirmed conclusion. Due to the inconclusive results of enteral glutamine supplementation trials in patients receiving enteral nutrition, future trials should focus on intravenous glutamine supplementation in patients requiring enteral nutrition and on major clinical outcome measures (e.g. mortality rate, infectious complications).

Hemorrhagic shock and tissue injury drive distinct plasma metabolome derangements in swine

“…by measuring base deficit, strong anion gap and plasma lactate levels 22–24 ). At the same time, metabolic approaches are key in defining effective resuscitation strategies to meet the increased physiologic demands of critically injured patients by providing specific metabolic substrates such as glutamine 12,25–27 and arginine 28–32 , either alone or in combination with omega-3 fatty acids and nucleotides 33 . Recently, we applied metabolomics technologies to delineate the metabolic derangements in hemorrhaged rodents and critically ill patients to identify shared perturbations of the post-shock metabolic pathways observed in the animal model and the clinical setting 4,6,10,13 .…”

Effect of Glutamine Enriched Nutrition Support on Surgical Patients with Gastrointestinal Tumor

“…Gastrointestinal cancer patients often accompanied by malnutrition and immune dysfunction, thereby slowing the recovery after surgical trauma and increasing mortality. [ 28 29 ] During surgical stress, the consumption of Gln exceeds the synthesis, resulting in depletion of Gln stores. [ 30 ] Moreover, the limited intestinal reserves and surgical fasting period would further aggravating relative lack of Gln.…”

Immunonutrition – the influence of early postoperative glutamine supplementation in enteral/parenteral nutrition on immune response, wound healing and length of hospital stay in multiple trauma patients and patients after extensive surgery

“…Major advantages include maintenance of the gastrointestinal function and stress ulcer prevention. Moreover, enteral nutrition helps to improve the gastrointestinal function and thus to support regional defence mechanisms and ultimately to strengthen the immune system [ 3 ], [ 4 ], [ 7 ], [ 27 ], [ 30 ], [ 43 ]. For example, burn patients and patients after surgery for malignant neoplasms who received enteral nutrition therapy had lower complication rates and shorter hospital stays [ 33 ], [ 35 ].…”

“…Clinical observations suggest that the positive effect of early nutritional therapy can be enhanced by adding certain nutrients that have a positive effect on the immune system. Pilot studies have shown that glutamine, arginine and omega-3 fatty acids have positive effects on the immune status of critically ill patients [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 12 ].…”

“…The aim of this study was to examine the effect of an enteral supplementation of glutamine, arginine and omega-3 fatty acids on immune function, wound healing, and length of hospital stay in multiple-trauma patients and patients after extensive surgery. Knowledge acquired from this study may be transferred to patients with burn injuries or extensive soft tissue injuries similar to those sustained in war [ 3 ], [ 12 ], [ 22 ], [ 23 ], [ 32 ], [ 33 ], [ 34 ], [ 35 ]. The prognosis of such patients may be considerably improved by early metabolically optimised and immunomodulatory nutrition via the enteral route, which is associated with significantly fewer complications.…”