Does the addition of glutamine to enteral feeds affect patient mortality?*

Schulman, Andrew; Willcutts, Kate; Claridge, Jeffrey A.; Evans, Heather L.; Radigan, Amy E.; O’Donnell, Kelly; Camden, Jeremy R.; Chong, Tae W.; McElearney, Shannon T.; Smith, Robert L.; Gazoni, Leo M.; Farinholt, Heidi Marie A; Heuser, Cara; Lowson, Stuart M.; Schirmer, Bruce D.; Young, Jeffrey S.; Sawyer, Robert G.

doi:10.1097/01.ccm.0000185643.02676.d3

Cited by 70 publications

(24 citation statements)

References 41 publications

(56 reference statements)

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“…Many studies [4,23,24] and meta-analyses [17,25] of randomized trials suggest that nutritional glutamine supplementation in surgical critically ill patients may be associated with improved survival. Our subgroup meta-analyses suggested that the effect of glutamine supplementation differed by ICU setting.…”

Section: Discussionmentioning

confidence: 99%

The effect of glutamine therapy on outcomes in critically ill patients: a meta-analysis of randomized controlled trials

Chen

Yang

et al. 2014

Critical Care

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IntroductionGlutamine supplementation is supposed to reduce mortality and nosocomial infections in critically ill patients. However, the recently published reducing deaths due to oxidative stress (REDOX) trials did not provide evidence supporting this. This study investigated the impact of glutamine-supplemented nutrition on the outcomes of critically ill patients using a meta-analysis.MethodsWe searched for and gathered data from the Cochrane Central Register of Controlled Trials, MEDLINE, Elsevier, Web of Science and ClinicalTrials.gov databases reporting the effects of glutamine supplementation on outcomes in critically ill patients. We produced subgroup analyses of the trials according to specific patient populations, modes of nutrition and glutamine dosages.ResultsAmong 823 related articles, eighteen Randomized Controlled Trials (RCTs) met all inclusion criteria. Mortality events among 3,383 patients were reported in 17 RCTs. Mortality showed no significant difference between glutamine group and control group. In the high dosage subgroup (above 0.5 g/kg/d), the mortality rate in the glutamine group was significantly higher than that of the control group (relative risk (RR) 1.18; 95% confidence interval (CI), 1.02 to 1.38; P = 0.03). In 15 trials, which included a total of 2,862 patients, glutamine supplementation reportedly affected the incidence of nosocomial infections in the critically ill patients observed. The incidence of nosocomial infections in the glutamine group was significantly lower than that of the control group (RR 0.85; 95% CI, 0.74 to 0.97; P = 0.02). In the surgical ICU subgroup, glutamine supplementation statistically reduced the rate of nosocomial infections (RR 0.70; 95% CI, 0.52 to 0.94; P = 0.04). In the parental nutrition subgroup, glutamine supplementation statistically reduced the rate of nosocomial infections (RR 0.83; 95% CI, 0.70 to 0.98; P = 0.03). The length of hospital stay was reported in 14 trials, in which a total of 2,777 patients were enrolled; however, the patient length of stay was not affected by glutamine supplementation.ConclusionsGlutamine supplementation conferred no overall mortality and length of hospital stay benefit in critically ill patients. However, this therapy reduced nosocomial infections among critically ill patients, which differed according to patient populations, modes of nutrition and glutamine dosages.

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Section: Discussionmentioning

confidence: 99%

The effect of glutamine therapy on outcomes in critically ill patients: a meta-analysis of randomized controlled trials

Chen

Yang

et al. 2014

Critical Care

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“…Indeed, a recent Canadian meta-analysis of parenteral glutamine administration in critically ill patients showed a significant benefit for both mortality and infectious complications (39) (www.criticalcarenutrition.com) but could only find a mortality benefit for enteral glutamine in patients with burns and reduced infectious complications in patients with burns or after trauma (37). Since this analysis a further study of enteral glutamine supplementation in patients in a surgical trauma ICU has failed to identify any outcome benefit (40,41).…”

Section: Discussionmentioning

confidence: 90%

Early enteral supplementation with key pharmaconutrients improves Sequential Organ Failure Assessment score in critically ill patients with sepsis: Outcome of a randomized, controlled, double-blind trial*

Beale

Sherry

Lei

et al. 2008

Critical Care Medicine

151

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“…27 Another study examining the use of enteral glutamine in 185 combined surgical and trauma patients also failed to show differences in mortality, mean number of infections, mechanical ventilation duration, ICU length of stay, and hospital length of stay. 30 In a subgroup analysis of causes of death in all patients, a statistically significant greater percentage of patients (70% vs 25%) who received glutamine supplementation died of sepsis or multiple-organ failure compared with the control group. Similarly, we found a greater occurrence of bloodstream infection with glutamine supplementation.…”

Section: Discussionmentioning

confidence: 93%

Enteral Glutamine Supplementation in Critically Ill Patients with Burn Injuries: A Retrospective Case‐Control Evaluation

Juang

Fish²,

Jung³

et al. 2007

Pharmacotherapy

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Enteral glutamine supplementation was not associated with a change in the cumulative rate of infectious complications compared with the control group, but this was attributed to more cases of bloodstream infections and fewer cases of pneumonia and cellulitis in the glutamine group. Large, prospective, randomized trials designed to detect small but clinically relevant outcomes are needed to definitively determine the effect of enteral glutamine supplementation in the BICU population.

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Does the addition of glutamine to enteral feeds affect patient mortality?*

Abstract: The addition of glutamine to standard enteral feeds or to an immunomodulatory formula did not improve outcomes. These findings suggest that enteral glutamine should not be routinely administered to patients with surgical critical illness.

Cited by 70 publications

References 41 publications

The effect of glutamine therapy on outcomes in critically ill patients: a meta-analysis of randomized controlled trials

The effect of glutamine therapy on outcomes in critically ill patients: a meta-analysis of randomized controlled trials

Early enteral supplementation with key pharmaconutrients improves Sequential Organ Failure Assessment score in critically ill patients with sepsis: Outcome of a randomized, controlled, double-blind trial*

Enteral Glutamine Supplementation in Critically Ill Patients with Burn Injuries: A Retrospective Case‐Control Evaluation

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