Comparison of the efficacy of parenteral glutamine and branched-chain amino acid solutions given as extra supplements in parallel to the enteral nutrition in head trauma

Asu, Ozgultekin; Turan, G.; Durmuş, Y.; Dinçer, Emine; Akgün, Nur

doi:10.1016/j.eclnm.2008.05.006

Cited by 9 publications

(11 citation statements)

References 23 publications

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“…Subgroup analyses suggested that GLN given at a dose greater that 0.2 g/kg/day and for at least 9 days was associated with a decreased mortality rate. The main differences with the present analysis are the exclusion of trials using enteral GLN and the inclusion of burn patients and the additional 9 studies 22 , 23 , 25 , 28 , 30 , 32 , 39 , 41 , 43 that we evaluated. Moreover, at the time of their publication, the results of 2 relevant RCTs 10 , 14 were not yet available.…”

Section: Discussionmentioning

confidence: 99%

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Glutamine Supplementation in Intensive Care Patients

et al. 2015

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The role of glutamine (GLN) supplementation in critically ill patients is controversial. Our aim was to analyze its potential effect in patients admitted to intensive care unit (ICU).We performed a systematic literature review through Medline, Embase, Pubmed, Scopus, Ovid, ISI Web of Science, and the Cochrane-Controlled Trials Register searching for randomized clinical trials (RCTs) published from 1983 to 2014 and comparing GLN supplementation to no supplementation in patients admitted to ICU. A random-effect meta-analysis for each outcome (hospital and ICU mortality and rate of infections) of interest was carried out. The effect size was estimated by the risk ratio (RR).Thirty RCTs were analyzed with a total of 3696 patients, 1825 (49.4%) receiving GLN and 1859 (50.6%) no GLN (control groups). Hospital mortality rate was 27.6% in the GLN patients and 28.6% in controls with an RR of 0.93 (95% CI = 0.81–1.07; P = 0.325, I2 = 10.7%). ICU mortality was 18.0 % in the patients receiving GLN and 17.6% in controls with an RR of 1.01 (95% CI = 0.86–1.19; P = 0.932, I2 = 0%). The incidence of infections was 39.7% in GLN group versus 41.7% in controls. The effect of GLN was not significant (RR = 0.88; 95% CI = 0.76–1.03; P = 0.108, I2 = 56.1%).These results do not allow to recommend GLN supplementation in a generic population of critically ills. Further RCTs are needed to explore the effect of GLN in more specific cohort of patients.

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Section: Discussionmentioning

confidence: 99%

“… 54 Once more, we found 16 additional trials to be analyzed. 14 , 21 , 24 , 26 , 28 , 30 – 33 , 35 , 38 , 39 , 41 , 43 , 44 …”

Section: Discussionmentioning

confidence: 99%

Glutamine Supplementation in Intensive Care Patients

et al. 2015

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“…There were 11 new RCTs comparing supplementation with parenteral glutamine to no glutamine supplementation in critically ill adults 34 – 44 . When the data from these trials were aggregated with those of the previous 17 RCTs in this area, there were weaker signals for a reduction in overall mortality (RR = 0.88, 95% CI = 0.75, 1.03, p = 0.10, heterogeneity I 2 = 0% in 2013 vs RR = 0.71, 95% CI = 0.55, 0.92, P = .008, heterogeneity I 2 = 0% in 2009) and infectious complications (RR = 0.86, 95% CI = 0.73, 1.02, p = 0.09, heterogeneity I 2 = 43% in 2013 vs RR = 0.76, 95% CI = 0.62, 0.93, P = .008, heterogeneity I 2 = 28.3% in 2009) and yet a strong treatment effect of IV supplemented glutamine on hospital mortality and ICU and hospital length of stay remained.…”

Section: Update Of the Ccpgsmentioning

confidence: 99%

The Canadian Critical Care Nutrition Guidelines in 2013

et al. 2013

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Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners and patient decisions about appropriate healthcare for specific clinical circumstances, and are designed to minimize practice variation, improve costs, and improve clinical outcomes. The Canadian Critical Care Practice Guidelines (CCPGs) were first published in 2003 and most recently updated in 2013. A total of 68 new randomized controlled trials were identified since the last version in 2009, 50 of them published between 2009 and 2013. The remaining articles were trials published before 2009 but were not identified in previous iterations of the CCPGs. For clinical practice guidelines to be useful to practitioners, they need to be up-to-date and be reflective of the current body of evidence. Herein we describe the process by which the CCPGs were updated. This process resulted in 10 new sections or clinical topics. Of the old clinical topics, 3 recommendations were upgraded, 4 were downgraded, and 27 remained the same. To influence decision making at the bedside, these updated guidelines need to be accompanied by active guideline implementation strategies. Optimal implementation strategies should be guided by local contextual factors including barriers and facilitators to best practice recommendations. Moreover, evaluating and monitoring performance, such as participating in the International Nutrition Survey of practice, should be part of any intensive care unit's performance improvement strategy. The active implementation of the updated CCPGs may lead to better nutrition care and improved patient outcomes in the critical care setting.

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“…Hartl and colleagues demonstrated that every 10kcal/kg decrease in energy increased mortality by 30-40% 41 . A reduction in ICU LOS was shown with the provision of probiotics delivered nasogastrically 48 , and a glutamine-probiotic combination 47 , but not with a glutamine-BCAA combination 46 .…”

Section: Type Of Nutrients Providedmentioning

confidence: 94%

“…As summarised in Table 1, five primary research studies (four RCTs [46][47][48][49] , and one cohort study 41 ) considered the effect of specific nutrient provision on TBI outcomes. Studies investigating the addition of glutamine and branched-chain amino acid (BCAA) 46 , probiotics 48 , or immunonutrient-rich enteral nutrition 49 , found no impact on mortality. Hartl and colleagues demonstrated that every 10kcal/kg decrease in energy increased mortality by 30-40% 41 .…”

Section: Type Of Nutrients Providedmentioning

confidence: 99%

Nutrition therapy in the optimisation of health outcomes in adult patients with moderate to severe traumatic brain injury: Findings from a scoping review

Costello

Lithander

Gruen

et al. 2014

Injury

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Inconsistency within nutrition intervention methods and outcome measures means that the present evidence base is inadequate for the construction of best practice guidelines for nutrition and TBI. Further research is necessary to elucidate the optimal nutrition therapy for adults with TBI with respect to the timing, route of administration, nutrient provision and feeding environment. A consensus on the ideal outcome measure and the most appropriate method and timing of its measurement is required as a foundation for this evidence base.

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Comparison of the efficacy of parenteral glutamine and branched-chain amino acid solutions given as extra supplements in parallel to the enteral nutrition in head trauma

Cited by 9 publications

References 23 publications

Glutamine Supplementation in Intensive Care Patients

Glutamine Supplementation in Intensive Care Patients

The Canadian Critical Care Nutrition Guidelines in 2013

Nutrition therapy in the optimisation of health outcomes in adult patients with moderate to severe traumatic brain injury: Findings from a scoping review

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