Glutamine in critically ill patients: is it a fundamental nutritional supplement?

Martins, Paulo

doi:10.5935/0103-507x.20160022

Cited by 4 publications

(7 citation statements)

References 38 publications

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“…An early response to such stress is a rapid release of muscle glutamine, followed by decrease in both muscle and plasma free glutamine concentrations. [20] Consequently, there is an upregulation of muscle glutamine synthesis from amino acids derived from a net increase in muscle proteolysis. [20] Hence exogenous supplementation of glutamine seems to be warranted for immunomodulatory responses and to prevent the loss of lean body muscle from proteolysis.…”

Section: En-enteral Nutritionmentioning

confidence: 99%

“…[20] Consequently, there is an upregulation of muscle glutamine synthesis from amino acids derived from a net increase in muscle proteolysis. [20] Hence exogenous supplementation of glutamine seems to be warranted for immunomodulatory responses and to prevent the loss of lean body muscle from proteolysis. However, evidence on the beneficial effects of glutamine has been controversial.…”

Section: En-enteral Nutritionmentioning

confidence: 99%

“…While small single centre studies demonstrated a significant reduction in mortality and infectious morbidity with glutamine supplementation, the more recent large, multicenter studies did not confirm this finding. [1,20] REDOXS study, being one of the large multicentre RCTs, showed deleterious effect on mortality among patients with multi-organ failure when given high dose of glutamine. [1,20] Another RCT, Signet trial, did not demonstrate significant difference in patient group receiving glutamine of 20.2g/day, which falls within the recommended dose of 0.3-0.6g/kg/day for a standard-sized patient weighed approximately 60 kg.…”

Section: En-enteral Nutritionmentioning

confidence: 99%

“…[1,20] REDOXS study, being one of the large multicentre RCTs, showed deleterious effect on mortality among patients with multi-organ failure when given high dose of glutamine. [1,20] Another RCT, Signet trial, did not demonstrate significant difference in patient group receiving glutamine of 20.2g/day, which falls within the recommended dose of 0.3-0.6g/kg/day for a standard-sized patient weighed approximately 60 kg. [20] Hence to date, no conclusive result can be drawn from addition of glutamine to critically ill patients, except that it shall not be given to unstable patients particularly those with renal and liver failure.…”

Section: En-enteral Nutritionmentioning

confidence: 99%

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Are we Giving Sufficient Protein in Parenteral Nutrition Support? A Cross-sectional Study on Adult Patients in Intensive Care Units

Fong¹,

Saedon²,

Bangguan³

2021

JPPCM

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Protein plays a significant role in nutritional support, especially for patients at intensive care unit (ICU) who commonly suffer from net loss of protein. ASPEN and ESPEN guidelines recommend a minimum protein of 1.2g/kg/day for ICU patients; Kidney Disease: Improving Global Outcomes (KDIGO) recommends 0.8g/ kg/day for chronic kidney disease (CKD) stage 4 to 5. This study aimed to determine whether adequate protein was given to adult ICU patients and identify the factors for discrepancy in local settings. A crosssectional study including all adult ICU patients receiving parenteral nutrition (PN) in Hospital Queen Elizabeth (HQE) and HQE II was conducted from January 2018 to April 2019. Relevant information was obtained from patients' pharmacotherapy review forms. For patients receiving PN and enteral nutrition (EN) concurrently, protein from both sources was accounted for. Among the 52 patients, majority were male (n=41; 78.8%) with median age of 52 years old (IQR=34.5). Median duration of PN support was 6 days (IQR=6.3), and gastrointestinal perforation was the most common indication (n=11; 21.2%). All 45 non-CKD patients (86.5%) received minimum recommended protein of 1.2g/kg/day. Ten patients (19.2% out of 52) who received PN and EN concurrently received a higher average protein up to 1.5g/kg/day. Out of 7 patients (13.5%) with underlying CKD stage 4 to 5, two (3.8% of total 52 patients) received insufficient protein below 0.8g/kg/ day due to restriction of fluid (ROF). Majority of the patients received sufficient protein as per guidelines.In real-life practice, discrepancy may occur due to the fixed-content formulations of commercial PN bags.

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Section: En-enteral Nutritionmentioning

confidence: 99%

Section: En-enteral Nutritionmentioning

confidence: 99%

Section: En-enteral Nutritionmentioning

confidence: 99%

Section: En-enteral Nutritionmentioning

confidence: 99%

See 2 more Smart Citations

Are we Giving Sufficient Protein in Parenteral Nutrition Support? A Cross-sectional Study on Adult Patients in Intensive Care Units

Fong¹,

Saedon²,

Bangguan³

2021

JPPCM

View full text Add to dashboard Cite

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“…Also, there is the question about other ways to increase its concentration in the blood, and whether these methods effect a decrease in complication incidence. Answers to these questions could indicate how to manage patients both pre-and postoperatively [38], and are thus the basis for the present paper.…”

mentioning

confidence: 99%

“When is Glutamine Supplementation Beneficial?”

Matras¹,

Monika²,

Bartoszewska³

et al. 2018

J Nutr Disorders Ther

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The role of glutamine in metabolic processes has been quite extensively researched and described, though no consensus exists as to its role in treatment. It is considered significant mainly for ICU patients; though no clear criteria for including glutamine in treatment have been defined. It is known that glutamine should be administered as a complement to nutritional treatment, and not independently. The purpose of the paper was to identify practical criteria for determining the clinical benefits of glutamine supplementation. The study was performed in the years 2007-2015 at the 1st Department of General and Transplantation Surgery and Nutritional Therapy of the Lublin Medical University in Lublin, Poland. It included patients scheduled for surgery due to a gastrointestinal cancer. The final study group included 105 patients, 48 female and 57 male. We found that low blood concentration of glutamine was correlated with a higher incidence of postoperative complications. ROC analysis allowed for identification of glutamine concentration below which there is a very high risk of complications. The threshold glutamine value identified was 205.15 nmol/ml. Low total lymphocyte count and serum albumin concentration can help identify patients in whom glutamine supplementation can decrease postoperative complication incidence, especially in the case of malnourished patients. Glutamine supplementation before a scheduled surgical procedure may benefit patients with a preoperative glutamine concentration below 205.15 nmol/ml. Glutamine supplementation can benefit malnourished patients.

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Prevention of Severe Intestinal Barrier Dysfunction Through a Single-Species Probiotics is Associated With the Activation of Microbiome-Mediated Glutamate–Glutamine Biosynthesis

Leng

Jiang

Xing

et al. 2020

Shock

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Intra-abdominal hypertension (IAH), the leading complication in the intensive care unit, significantly disturbs the gut microbial composition by decreasing the relative abundance of Lactobacillus and increasing the relative abundance of opportunistic infectious bacteria. Methods: To evaluate the preventative effect of Lactobacillusbased probiotics on IAH-induced intestinal barrier damages, a single-species probiotics (L92) and a multispecies probiotics (VSL#3) were introduced orally to Sprague-Dawley rats for 7 days before inducing IAH. The intestinal histology and permeability to macromolecules (fluoresceine isothiocyanate, FITC-dextran, N ¼ 8 for each group), the parameters of immunomodulatory and oxidative responses [monocyte chemotactic protein 1 (MCP-1), interleukin-1b (IL-1b), interleukin-4 (IL-4), interleukin-10 (IL-10), malonaldehyde, glutathione peroxidase (GSH-Px), catalase (CAT), and superoxide dismutase; N ¼ 4 for each group], and the microbiome profiling (N ¼ 4 for each group) were analyzed. Results: Seven-day pretreatments of L92 significantly alleviated the IAH-induced increase in intestinal permeability to FITC-dextran and histological damage (P < 0.0001), accompanied with the suppression of inflammatory and oxidative activation. The increase of MCP-1 and IL-1b was significantly inhibited (P < 0.05); the anti-inflammatory cytokines, IL-4, and IL-10 were maintained at high levels; and the suppression of CAT (P < 0.05) was significantly reversed when pretreated with L92. On the contrary, no significant protective effects were observed in the VSL#3-pretreated group. Among the 84 identified species, 260 MetaCyc pathways, and 217 Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways, the protective effects of L92 were correlated with an increased relative abundance of Bacteroides finegoldii, Odoribacter splanchnicus, and the global activation of amino acid biosynthesis pathways, especially the glutamate-glutamine biosynthesis pathway. Conclusions: Seven-day pretreatment with a single-species probiotics can prevent IAH-induced severe intestinal barrier dysfunction, potentially through microbial modulation.

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Glutamine in critically ill patients: is it a fundamental nutritional supplement?

Cited by 4 publications

References 38 publications

Are we Giving Sufficient Protein in Parenteral Nutrition Support? A Cross-sectional Study on Adult Patients in Intensive Care Units

Are we Giving Sufficient Protein in Parenteral Nutrition Support? A Cross-sectional Study on Adult Patients in Intensive Care Units

“When is Glutamine Supplementation Beneficial?”

Prevention of Severe Intestinal Barrier Dysfunction Through a Single-Species Probiotics is Associated With the Activation of Microbiome-Mediated Glutamate–Glutamine Biosynthesis

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