Immunonutrition as an adjuvant therapy for burns

Tan, Hannah; Danilla, Stefan; Murray, Alexandra; Serra, Ramón; Dib, Regina El; Henderson, T.; Wasiak, Jason

doi:10.1002/14651858.cd007174.pub2

Cited by 27 publications

(24 citation statements)

References 110 publications

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“…58 Supplementation of glutamine, an essential amino acid in times of stress, was associated with a reduction in LOS and a reduction in mortality in a recent Cochrane Database metaanalysis of 16 trials. 59 However, the authors suggest that these findings should be interpreted with caution, given the small overall sample size. Supplementation of certain trace elements including vitamin C, selenium, and zinc has been studied without clear evidence of benefit.…”

Section: What's New?mentioning

confidence: 96%

“…Supplementation of certain trace elements including vitamin C, selenium, and zinc has been studied without clear evidence of benefit. 59 These substances are known to be depleted after thermal injury and can potentially contribute to immune dysfunction and disruption of mechanisms of wound healing. Our practice currently includes supplementation of all the above.…”

Section: What's New?mentioning

confidence: 99%

See 1 more Smart Citation

Update on Severe Burn Management for the Intensivist

Lundy

Chung

Pamplin

et al. 2016

J Intensive Care Med

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Thermal injury of humans causes arguably the most severe perturbations in physiology that can be experienced. These physiologic derangements start immediately and can persist in some form until months or even years after the burn wounds are healed. Burn shock, marked activation of the systemic inflammatory response, multiple-organ failure, infection, and wound failure are just a few of the insults that may require management by the intensivist. The purpose of this article is to review recent advances in the critical care management of thermally injured patients.

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Section: What's New?mentioning

confidence: 96%

Section: What's New?mentioning

confidence: 99%

Update on Severe Burn Management for the Intensivist

Lundy

Chung

Pamplin

et al. 2016

J Intensive Care Med

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“…Initial reports focused on its use for victims of burn injuries, although interventions commonly consisted of single nutrient supplementation . Along with early enteral nutrition (EN) and protein delivery in the range of 1.5–2.5 g/kg/day, a standard polymeric formula administered continuously via small‐bowel feeding tube and supplemental vitamins and trace elements (zinc, copper, and selenium, and vitamins B1, C, D, and E) remains the current cornerstone of burn care . A recent systematic review of burn nutrition reported a mortality benefit from glutamine in this population, but authors cautioned that the number of study participants limits any broad recommendation for its routine use .…”

Section: Imn Definedmentioning

confidence: 99%

“…A recent systematic review of burn nutrition reported a mortality benefit from glutamine in this population, but authors cautioned that the number of study participants limits any broad recommendation for its routine use . No other immune‐modulating nutrient was found to exert a beneficial effect on mortality, LOS, burn wound infection, or infection rate in general . Guidelines from both the Society of Critical Care Medicine (SCCM)/American Society of Parenteral and Enteral Nutrition (ASPEN) and the European Society for Parenteral and Enteral Nutrition (ESPEN) recommend early EN over parenteral nutrition (PN) for improved gastrointestinal (GI) contractility, lower rate of ischemia/reperfusion injury, and reduced intestinal permeability reported in severe burn patients .…”

Section: Imn Definedmentioning

confidence: 99%

Immunonutrition in Critical Illness: What Is the Role?

McCarthy

Martindale

2018

Nut in Clin Prac

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Acute illness-associated malnutrition leads to muscle wasting, delayed wound healing, failure to wean from ventilator support, and possibly higher rates of infection and longer hospital stays unless appropriate metabolic support is provided in the form of nutrition therapy. Agreement is still lacking about the value of individual immune-modulating substrates for specific patient populations. However, it has long been agreed that there are 3 primary targets for these substrates: 1) mucosal barrier function, 2) cellular defense function, and 3) local and systemic inflammation. These targets guide the multitude of interventions necessary to stabilize and treat the hypercatabolic intensive care unit patient, including specialized nutrition therapy. The paradigm shift that occurred 30 years ago created a unique role for nutrition as an agent to support host defense mechanisms and prevent infectious complications in the critically ill patient. This overview of immunonutrition will discuss the evidence for its role in critical illness today.

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“…Based on this analysis and others, there is a potential role for glutamine supplementation in burn patients 57 , 58 . These patients are in a severe catabolic state and are especially prone to infections due to breakdown of the skin barrier 57 . A recent meta‐analysis assessing the effect of enteral glutamine supplementation in burn patients evaluated 4 RCTs involving 155 patients 58 .…”

Section: Critical Illness Glutamine Studiesmentioning

confidence: 99%

When Is It Appropriate to Use Glutamine in Critical Illness?

2016

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Glutamine is a nonessential amino acid, which under trauma or critical illness can become essential. A number of historic small single-center randomized controlled trials (RCTs) have demonstrated positive treatment effects on clinical outcomes with glutamine supplementation. Meta-analyses based on these trials demonstrated a significant reduction in hospital mortality, intensive care unit (ICU) length of stay (LOS), and hospital LOS with intravenous (IV) glutamine. Similar results were not noted in 2 large multicenter RCTs (REDOXS and MetaPlus) assessing the efficacy of glutamine supplementation in ventilated ICU patients. The REDOXS trial of 40 ICUs randomized 1223 ventilated ICU patients to glutamine (IV and enteral), antioxidants, both glutamine and antioxidants, or placebo. The main conclusions were a trend toward increased 28-day mortality and significant increased hospital and 6-month mortality in those who received glutamine. The MetaPlus trial of 14 ICUs, which randomized 301 ventilated ICU patients to glutamine-enriched enteral vs an isocaloric diet, noted increased 6-month mortality in the glutamine-supplemented group. Newer RCTs have focused on specific populations and have demonstrated benefits in burn and elective surgery patients with glutamine supplementation. Whether larger studies will confirm these findings is yet to be determined. Recent American Society for Parenteral and Enteral Nutrition guidelines recommend that IV and enteral glutamine should not be used in the critical care setting based on the moderate quality of evidence available. We agree with these recommendations and would encourage larger multicenter studies to evaluate the risks and benefits of glutamine in burn and elective surgery patients.

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Immunonutrition as an adjuvant therapy for burns

Cited by 27 publications

References 110 publications

Update on Severe Burn Management for the Intensivist

Update on Severe Burn Management for the Intensivist

Immunonutrition in Critical Illness: What Is the Role?

When Is It Appropriate to Use Glutamine in Critical Illness?

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