L-alanyl-L-glutamine dipeptide–supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: The French controlled, randomized, double-blind, multicenter study*

Abstract

TPN supplemented with Ala-Gln dipeptide in ICU patients is associated with a reduced rate of infectious complications and better metabolic tolerance.

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

“…24 We found that GLN supplementation in the nonpancreatic surgical cohort significantly decreased (by an average of 12 days) the number of days patients required mechanical ventilation, probably because of the reduced incidence of pneumonia. Dechelotte et al 42 recently demonstrated a significant decrease in the incidence of pneumonia and the average number of infections per patient with GLN-PN in a mixed medical/surgical patient population in 16 French ICUs. Larger trials that are powered to test the hypothesis that GLN-supplemented PN decreases ARDS and overall hospital mortality rates are needed.…”

“…Several controlled trials in specific subgroups of postsurgical and other types of patients have shown beneficial clinical or metabolic effects when GLN is added to PN. 25,[31][32][33][34][35]39,41,42 These studies have incorporated L-GLN doses in PN ranging from 0.29 to 0.57 g/kg/d, 25,[31][32][33][34][35]39 and alanyl-GLN dipeptide doses similar to the dose used in the current trial (0.40-0.50 g/kg/d or equivalent to 0.26-0.33 g of L-GLN/kg/d). However, several trials also show no benefits, possibly attributable to differences in study patient clinical characteristics and degree of GLN depletion within and between studies, as well as the dose of parenteral GLN used.…”

“…Our infection data are consistent with previous studies showing a beneficial effect of GLN-supplemented PN to decrease nosocomial infections in other types of critically ill patients. 31,[39][40][41][42] S aureus is responsible for a high percentage of nosocomial infections in postsurgical and ICU patients. [1][2][3][4][5] Our data show for the first time that GLN-supplemented PN specifically reduces infections attributed to S aureus, fungi, and enteric Gram-negative bacteria, which were markedly decreased with GLN-PN in the nonpancreatic surgery cohort ( Table 4).…”

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

“…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)…”

L-alanyl-glutamine pretreatment attenuates acute inflammatory response in children submitted to palatoplasty

“…GLN supplementation in patients submitted to elective surgery attenuates the negative postoperative nitrogen balance, diminishing the dive in intracellular concentration of the amino acid in skeletal muscle and enhancing the synthesis of muscle protein 5,6 . Parenteral nutrition supplemented with the dipeptide alanyl-glutamine in patients in an intensive care unit is associated with a reduction in infection complications and better metabolic tolerance 7 . The effect of parenteral GLN treatment has not been assessed in the setting of palatoplasty in children.…”