The effect of supplemental enteral glutamine on plasma levels, gut function, and outcome in severe burns: a randomized, double‐blind, controlled clinical trial

Abstract

Enteral gln supplementation using a commercially available dipeptide supported plasma gln levels, improved gut permeability, and initially decreased plasma endotoxin levels in severely thermally injured patients. These alterations were associated with a reduction in the length of hospitalization and lower costs.

Metabolic effects of enteral versus parenteral alanyl-glutamine dipeptide administration in critically ill patients receiving enteral feeding: A pilot study

“…Numerous animal studies and a few studies in catabolic patients have shown that enteral Gln improves gut barrier function as measured by bacterial translocation in animals [35] and gut permeability to sugar markers in humans [13]. In the current study, the lactulose/mannitol urinary excretion ratio was approximately twice as high as in a group of 10 healthy controls in our laboratory (not shown), but was unaffected by Gln dipeptide administration by either route.…”

“…During critical illness, Gln may become conditionally indispensable as evidenced by the fall in plasma and tissue concentration apparently as a result of Gln utilization exceeding endogenous production [5][6][7]. Previous studies suggest that improved plasma Gln concentrations may be beneficial for patients with critical illnesses to improve GSH biosynthesis in tissues [8], nitrogen balance [9], immune function [10][11][12], intestinal permeability [13] and the incidence of hospital-acquired infection [9,11].…”

“…Gln at doses up to 40 g/day is known to be safe when administered with enteral or parenteral nutrition (EN or PN, respectively) [7][8][9]13]; however, it is unclear which route of delivery is superior. There is evidence suggesting that Gln supplementation in PN may be superior to the enteral route in terms of clinical outcomes [11] and repletion of plasma Gln [12].…”

Nutritional support with glutamine according to recommendations of the European Society for Clinical Nutrition and Metabolism (ESPEN)

“…Wyniki tych badań i metaanaliz zostały przedstawione w podrozdziale dotyczącym intensywnej terapii [17][18][19]. Badania, w których stosowano dojelitowe leczenie żywieniowe wzbogacone tylko w glutaminę, przeprowadzano także w heterogennych grupach pacjentów OIT (wyniki przedstawiono w rozdziale dotyczącym intensywnej terapii [20][21][22]). Na ich podstawie nie można jednoznacznie podać zaleceń dotyczących stosowania dojelitowo glutaminy u chorych poddawanych zabiegom chirurgicznym.…”

“…Podobne badanie przeprowadzili także Zhou i wsp. [20], którzy 40 chorym po rozległych oparzeniach (50-80% powierzchni ciała) podawali dojelitowo przez 12 dni dietę standardową wzbogaconą w dipeptyd Ala--Gln (0,35 g/kg/dobę) lub niewzbogaconą. W grupie otrzymującej dipeptyd Ala --Gln poziom LPS był istotnie niższy (od 3. doby), a czas hospitalizacji istotnie krótszy niż w grupie żywionej standardowo.…”