A Randomized Trial of Enteral Glutamine for Treatment of Burn Injuries

Heyland, Daren K.; Wibbenmeyer, Lucy; Pollack, Jonathan A; Friedman, Bruce; Turgeon, Alexis F.; Eshraghi, Niknam; Jeschke, Marc G.; Bélisle, Sylvain; Grau, Daisy; Mandell, Samuel P.; Velamuri, Sai R; Hundeshagen, Gabriel; Moiemen, Naiem; Shokrollahi, Kayvan; Foster, Kevin N; Huss, Fredrik; Collins, Declan; Savetamal, Alisa; Gurney, Jennifer M; Depetris, Nadia; Stoppe, Christian; Ortiz-Reyes, Luis; Garrel, Dominique R.; Day, Andrew G.

doi:10.1056/nejmoa2203364

Cited by 37 publications

(29 citation statements)

References 28 publications

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“…Patients were randomized to receive 0.5 g/kg/day of enteral glutamine or placebo. In this trial, enteral glutamine had no effect on time-to-discharge alive, mortality or gram-negative bacteremias [6 ▪ ]. Importantly glutamine administration was not associated with adverse events.…”

Section: Recent Data and Future Challengesmentioning

confidence: 56%

Nutrition after severe burn injury

Rousseau

Pantet

Heyland

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewSevere burn injury causes significant metabolic changes and demands that make nutritional support particularly important. Feeding the severe burn patient is a real challenge in regard to the specific needs and the clinical constraints. This review aims to challenge the existing recommendations in the light of the few recently published data on nutritional support in burn patients.Recent findingsSome key macro- and micro-nutrients have been recently studied in severe burn patients. Repletion, complementation or supplementation of omega-3 fatty acids, vitamin C, vitamin D, antioxidant micronutrients may be promising from a physiologic perspective, but evidence of benefits on hard outcomes is still weak due to the studies’ design. On the contrary, the anticipated positive effects of glutamine on the time to discharge, mortality and bacteremias have been disproved in the largest randomized controlled trial investigating glutamine supplementation in burns. An individualized approach in term of nutrients quantity and quality may proof highly valuable and needs to be validated in adequate trials. The combination of nutrition and physical exercises is another studied strategy that could improve muscle outcomes.SummaryDue to the low number of clinical trials focused on severe burn injury, most often including limited number of patients, developing new evidence-based guidelines is challenging. More high-quality trials are needed to improve the existing recommendations in the very next future.

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Section: Recent Data and Future Challengesmentioning

confidence: 56%

Nutrition after severe burn injury

Rousseau

Pantet

Heyland

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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“…114 However, clinical evidence is still controversial, with three SRMAs (two published in 2017, one in 2021) showing fewer infections and reduced hospital LOS in ICU patients treated with glutamine. [115][116][117] The Randomized Trial of Enteral Glutamine to Minimize Thermal Injury (RE-ENERGIZE), an international multicenter RCT by Heyland and colleagues, 118 enrolled a total of 1209 patients with severe burns (mean burn size, 33% of total body surface area). The median time to discharge alive from the hospital (primary endpoint) was 40 days in the glutamine group and 38 days in the placebo group.…”

Section: Clinical Interpretationmentioning

confidence: 99%

“…No substantial between-group differences in serious adverse events were observed. 118 Based on these findings, the current ESPEN guideline, which recommends a moderate glutamine substitution in patients with severe burn injuries, needs to be revised.…”

Section: Clinical Interpretationmentioning

confidence: 99%

What the clinician needs to know about medical nutrition therapy in critically ill patients in 2023: A narrative review

et al. 2023

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Medical nutrition therapy (MNT) represents an essential element in the medical care of critically ill patients admitted to an intensive care unit (ICU).Increasing awareness exists that energy and nutrients not only preserve body structures such as lean body/muscle mass but also represent promising therapeutic elements to target the profound metabolic, inflammatory, endocrinologic, and immunologic alterations occurring during critical illness.However, despite intense research activities for years, diverse aspects of MNT such as the optimal timing, dosing, and composition of energy and macronutrient supply, as well as the role of micronutrients, are still an issue of debate resulting from strong heterogeneity in methods and findings of respective studies. These discrepancies are also reflected in diverging recommendations of international clinical nutrition guidelines for specific topics. In addition, implementing targeted, personalized MNT strategies in routine clinical practice underlies difficulties and challenges resulting from disease-specific issues and/or organizational, structural, and educational aspects. This narrative review aims to summarize the most recent evidence relevant to clinical practice on selected aspects of MNT in adult patients in the ICU and to provide guidance for implementing evidence-based approaches for adequate energy and nutrient supply in the ICU setting.

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“…Auch bei Ernährungsinterventionen bedeutet daher "mehr" nicht immer "besser". Supraphysiologische Dosierungen von Makro-und Mikronährstoffen zur gezielten Verbesserung von Organfunktionen und des Immunsystems lieferten zuletzt besonders in den internationalen multizentrischen Studien neutrale oder gar negative Ergebnisse [9][10][11][12][13], sodass deren klinischer Einsatz vielmehr individualisiert und gezielt erfolgen soll [4].…”

Section: Optimum?unclassified

Immunonutrition—In search of the optimum

Hill

2023

Anaesthesiologie

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A Randomized Trial of Enteral Glutamine for Treatment of Burn Injuries

Cited by 37 publications

References 28 publications

Nutrition after severe burn injury

Nutrition after severe burn injury

What the clinician needs to know about medical nutrition therapy in critically ill patients in 2023: A narrative review

Immunonutrition—In search of the optimum

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