Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma

Houdijk, Alexander P. J.; Rijnsburger, E.R.; Jansen, Jaap; Wesdorp, R. I. C.; Weiss, Jeffery K; McCamish, Mark; Teerlink, Tom; Meuwissen, S. G. M.; Haarman, H. J. T. M.; Thijs, L. G.; Leeuwen, P.A. van

doi:10.1016/s0140-6736(98)02007-8

Cited by 590 publications

(308 citation statements)

References 24 publications

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“…Also, metabolic results with enteral Gln administration have been inconsistent across studies (27,28). The current study is the first to directly compare whether intravenous AG was superior to enteral AG in terms of short-term metabolic endpoints in tubefed ICU patients.…”

Section: Discussionmentioning

confidence: 94%

Metabolic effects of enteral versus parenteral alanyl-glutamine dipeptide administration in critically ill patients receiving enteral feeding: A pilot study

et al. 2008

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Section: Discussionmentioning

confidence: 94%

Metabolic effects of enteral versus parenteral alanyl-glutamine dipeptide administration in critically ill patients receiving enteral feeding: A pilot study

et al. 2008

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“…Wyniki tych badań i metaanaliz zostały przedstawione w podrozdziale dotyczącym intensywnej terapii [17][18][19]. Badania, w których stosowano dojelitowe leczenie żywieniowe wzbogacone tylko w glutaminę, przeprowadzano także w heterogennych grupach pacjentów OIT (wyniki przedstawiono w rozdziale dotyczącym intensywnej terapii [20][21][22]). Na ich podstawie nie można jednoznacznie podać zaleceń dotyczących stosowania dojelitowo glutaminy u chorych poddawanych zabiegom chirurgicznym.…”

Section: Zalecenia Espen Dla Chorych Poddawanych Zabiegom Chirurgicznymunclassified

“…[21] w badaniu z randomizacją wykonanym w grupie 72 chorych po rozległych urazach [skala ciężkości urazu (Injury Severity Score -ISS) > 20] stwierdzili, że w porównaniu z dojelitowym żywieniem standardowym, żywienie wzbogacone glutaminą (30,5 g/100 g białka przez okres minimum 5 dni) powoduje istotne obniżenie częstości występowania zapaleń płuc, bakteriemii, sepsy, wyższe stężenie glutaminy w osoczu (w 3.-5. dobie) oraz niższe stężenie sTNFR (od 4. doby). Conejero i wsp.…”

Section: Intensywna Terapiaunclassified

Nutritional support with glutamine according to recommendations of the European Society for Clinical Nutrition and Metabolism (ESPEN)

Kędziora¹,

Słotwiński²,

Dąbrowska³

2010

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StreszczenieW stanach stresu metabolicznego (np. urazy, zapalenia, oparzenia, choroby nowotworowe, kacheksja) glutamina wykorzystywana jest jako źródło energii w większych ilościach niż w stanie fizjologicznym i staje się związkiem warunkowo niezbędnym. Dlatego też w takich sytuacjach zalecana jest jej suplementacja. Europejskie Towarzystwo Żywienia Klinicznego i Metabolizmu (ESPEN) od 2005 r. przedstawia zalecenia żywieniowe dotyczące pozajelitowego lub dojelitowego stosowania glutaminy w poszczególnych jednostkach chorobowych i konkretnych sytuacjach klinicznych. Niniejsza praca ma na celu zebranie i uporządkowanie aktualnych zaleceń ESPEN dotyczących suplementacji tego aminokwasu zarówno w żywieniu enteralnym, jak i parenteralnym. AbstractIn conditions of metabolic stress (trauma, burns, cancer, cachexia) glutamine as a source of energy is used more than in the physiological state and becomes a conditionally essential amino acid. Because of this, glutamine should be supplemented in these conditions. The European Society for Clinical Nutrition and Metabolism (ESPEN) since 2005 has presented recommendations of glutamine's use in different diseases and clinical states. This article presents current recommendations of glutamine supplementation in both enteral and parenteral nutrition.

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“…In a study in rats, we observed a reduced blood flow to the small intestine when plasma concentrations of arginine were low in the presence of low-grade endotoxemia (Prins et al, 2000a). Circulating arginine is reduced in a number of clinical conditions, for example, after thoracoabdominal aortic surgery (Nijveldt et al, 2000), after surgery for esophageal and lung cancer (Naini et al, 1988), after trauma (Houdijk et al, 1998), during sepsis (Freund et al, 1978), and in severe burns (Yu et al, 1995). Because of the many physiological functions of arginine, low levels of this amino acid may be related to the high morbidity and mortality rates in these patient groups.…”

Section: Introductionmentioning

confidence: 98%

High plasma arginine concentrations in critically ill patients suffering from hepatic failure

et al. 2004

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Objective: In physiological conditions, the liver plays an important role in the regulation of plasma arginine concentrations by taking up large amounts of arginine from the hepatic circulation. When hepatic failure is present, arginine metabolism may be disturbed. Therefore, we hypothesized high arginine plasma concentrations in critically ill patients suffering from hepatic failure. Design: We prospectively collected blood samples from a cross-section of intensive care unit patients. Setting: Surgical intensive care unit of a Dutch university medical center. Subjects: A total of 52 critically ill patients with clinical evidence of dysfunction of more than two organs were recruited. Measurements: Plasma arginine concentrations were determined by HPLC. We identified correlations of arginine concentrations with organ failure scores and laboratory variables by univariate and multiple regression analyses. Results: High plasma arginine concentrations were found in critically ill patients developing organ failure. Patients who were in the highest quartile of plasma arginine concentrations had significantly lower fibrinogen concentrations, higher lactic acid concentrations, and longer prothrombin time. Stepwise multiple regression analysis showed that concentrations of arginine were independently associated with the presence of hepatic failure (P ¼ 0.03) and renal failure (P ¼ 0.048). In addition, lactic acid proved to be an independent determinant of plasma arginine concentration (P ¼ 0.014). Conclusions: Critically ill patients who suffer from hepatic failure have elevated plasma arginine concentrations. Additional arginine in the treatment of these patients can be harmful, and therefore should not be used as a standard nutritional regimen until further evaluation.

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Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma

Cited by 590 publications

References 24 publications

Metabolic effects of enteral versus parenteral alanyl-glutamine dipeptide administration in critically ill patients receiving enteral feeding: A pilot study

Metabolic effects of enteral versus parenteral alanyl-glutamine dipeptide administration in critically ill patients receiving enteral feeding: A pilot study

Nutritional support with glutamine according to recommendations of the European Society for Clinical Nutrition and Metabolism (ESPEN)

High plasma arginine concentrations in critically ill patients suffering from hepatic failure

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