Efficacy of Parenteral Nutrition Supplemented With Glutamine Dipeptide to Decrease Hospital Infections in Critically Ill Surgical Patients

Estívariz, Concepción F.; Griffith, Daniel; Luo, Menghua; Szeszycki, Elaina E.; Bazargan, Niloofar; Davé, Nisha; Daignault, Nicole M; Bergman, Glen F; McNally, Therese A.; Battey, Cindy H.; Furr, Celeste E; Hao, Lirong; Ramsay, James G.; Accardi, Carolyn R.; Cotsonis, George; Jones, Dean P.; Galloway, John R.; Ziegler, Thomas R.

doi:10.1177/0148607108317880

Cited by 84 publications

(62 citation statements)

References 68 publications

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“…Eight trials were in patients undergoing elective gastrointestinal surgery, for whom parenteral nutrition support post-operatively would not normally be provided. One trial Parenteral nutrition Estivariz et al (16) Fuentes-Orozco et al (18) Fuentes-Orozco et al (17) Goeters et al (20) Griffiths et al (21) Sahin et al (38) Wischmeyer et al (42) Subtotal (95 % CI)…”

Section: Resultsmentioning

confidence: 99%

“…High-dose glutamine Conejero et al (13) Estivariz et al (16) Fuentes-Orozco et al (17) Garrel et al (19) Goeters et al (20) Houdijk et al (23) McQuiggan et al (29) Schulman et al (39) Subtotal (95 % CI) Total events: 44 (treatment), 60 (control) Test for heterogeneity: χ 2 16·1, df 7 (P=0·02), I 2 56·6 % Test for overall effect: Z 1·90 (P=0·06)…”

Section: Discussionmentioning

confidence: 99%

“…Critical illness PN de Beaux et al (14) Déchelotte et al (15) Estivariz et al (16) Fuentes-Orozco et al (18) Fuentes-Orozco et al (17) Griffiths et al (21) Ockenga et al (33) Perez-Barcena et al (36) Sahin et al (38) Wischmeyer et al (42) Subtotal (95 % CI) Total events: 104 (treatment), 136 (control) Test for heterogeneity: χ 2 12·9, df 9 (P=0·17), I 2 30·4 % Test for overall effect: Z 2·24 (P=0·03)…”

Section: Methodsmentioning

confidence: 99%

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Symposium 4: Hot topics in parenteral nutrition Current evidence and ongoing trials on the use of glutamine in critically-ill patients and patients undergoing surgery

Avenell

2009

Proc. Nutr. Soc.

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The amino acid glutamine has numerous important roles including particularly antioxidant defence, immune function, the inflammatory response, acid–base balance and N economy. The present systematic review of randomised controlled trials of nutrition support with glutamine up to August 2008 has found that parenteral glutamine in critical illness is associated with a non-significant reduction in mortality (risk ratio 0·71 (95% CI 0·49, 1·03)) and may reduce infections. However, poor study quality and the possibility of publication bias mean that these results should be interpreted with caution. There is no evidence to suggest that glutamine is harmful in terms of organ failure and parenteral glutamine may reduce the development of organ failure.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Symposium 4: Hot topics in parenteral nutrition Current evidence and ongoing trials on the use of glutamine in critically-ill patients and patients undergoing surgery

Avenell

2009

Proc. Nutr. Soc.

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“…Total parenteral nutrition supplemented with alanil-glutamine dipeptide in ICU patients was associated with a reduced rate of infection, including the incidence of pneumonia, but it did not improve survival (Déchelotte et al 2006). Surgical patients treated with parenteral nutrition containing alanil-glutamine dipeptide demonstrated reduced infectious morbidity rate (Estívariz et al 2008, FuentesOrozco et al 2008, as well as a significantly higher serum HSP70 level (Ziegler et al 2005), which is correlated with a decrease in ICU length of stay. Patients after portal hypertension surgery receiving total parenteral nutrition supplemented with Gln presented an improvement in immune function and preservation of intestinal integrity (Tang et al 2007) (Table I).…”

Section: Clinical Studiesmentioning

confidence: 98%

Understanding the mechanisms of glutamine action in critically ill patients

Oliveira

Dias

Pelosi

et al. 2010

An. Acad. Bras. Ciênc.

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Glutamine (Gln) is an important energy source and has been used as a supplementary energy substrate. Furthermore, Gln is an essential component for numerous metabolic functions, including acid-base homeostasis, gluconeogenesis, nitrogen transport and synthesis of proteins and nucleic acids. Therefore, glutamine plays a significant role in cell homeostasis and organ metabolism. This article aims to review the mechanisms of glutamine action during severe illnesses. In critically ill patients, the increase in mortality was associated with a decreased plasma Gln concentration. During catabolic stress, Gln consumption rate exceeds the supply, and both plasma and skeletal muscle pools of free Gln are severely reduced. The dose and route of Gln administration clearly influence its effectiveness: high-dose parenteral appears to be more beneficial than low-dose enteral administration. Experimental studies reported that Gln may protect cells, tissues, and whole organisms from stress and injury through the following mechanisms: attenuation of NF (nuclear factor)-κB activation, a balance between pro-and anti-inflammatory cytokines, reduction in neutrophil accumulation, improvement in intestinal integrity and immune cell function, and enhanced of heat shock protein expression. In conclusion, high-doses of parenteral Gln (>0.50 g/kg/day) demonstrate a greater potential to benefit in critically ill patients, although Gln pathophysiological mechanisms requires elucidation.

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“…Particularly in studies conducted after the 2000s, the addition of glutamine to the nutritional solutions of patients in critical care or undergoing surgery was shown to reduce the rates of infectious complications and mortality (38)(39)(40)(41). These studies were conducted on homogeneous groups of patients.…”

Section: Glutaminementioning

confidence: 99%

Malnutrition in Intensive Care Units: An Important Risk Factor for Intensive Care Unit-Acquired Infections

Gündoğan

Bayram²,

Alp

2015

Yoğun Bakim Derg

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Intensive care units have the highest prevalence of nosocomial infections in hospitals. Good nutritional support is essential to prevent nosocomial infections. However, malnutrition is a common and important problem in intensive care units, especially in developing countries. For the prevention of malnutrition, a team approach is needed. Immunonutrition is nutrition that affects the immune response in various ways and increases the strength of the immune system. Pharmaconutrition is the administration of immunonutrients over the daily recommended doses that act like pharmacological agents and drugs. The major immunonutrients are glutamine, arginine, omega-3 fatty acids, nucleotides, antioxidants (selenium, vitamin E, vitamin C, zinc, copper, and Nacetyl cysteine), probiotics, prebiotics, and synbiotics. The aim of this review is to highlight the pathophysiology and role of malnutrition in intensive care unit-acquired infections (ICU-AIs) and the use of immunonutrients to prevent ICU-AIs. (Yoğun Bakım Derg 2014; 5: 36-42)

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Efficacy of Parenteral Nutrition Supplemented With Glutamine Dipeptide to Decrease Hospital Infections in Critically Ill Surgical Patients

Cited by 84 publications

References 68 publications

Symposium 4: Hot topics in parenteral nutrition Current evidence and ongoing trials on the use of glutamine in critically-ill patients and patients undergoing surgery

Symposium 4: Hot topics in parenteral nutrition Current evidence and ongoing trials on the use of glutamine in critically-ill patients and patients undergoing surgery

Understanding the mechanisms of glutamine action in critically ill patients

Malnutrition in Intensive Care Units: An Important Risk Factor for Intensive Care Unit-Acquired Infections

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