Decreased mortality and infectious morbidity in adult burn patients given enteral glutamine supplements: a prospective, controlled, randomized clinical trial.
OBJECTIVE
Enteral glutamine supplements have been shown to reduce infectious morbidity in trauma patients, but their effect on burn patients is not known. The objective of this study was to measure the impact of enteral glutamine supplementation on infectious morbidity, length of care, and the immune system in burn patients.


METHODS
Double-blinded, randomized clinical trial.


METHODS
Burn center.


METHODS
Forty-five adults with severe burns.


METHODS
Patients were randomized to receive either glutamine or an isonitrogenous control mixture until complete healing occurred. Length of care, incidence of positive blood culture, and mortality were recorded. Phagocytosis by circulating polymorphonuclear cells was measured every 3 days.


RESULTS
Patient characteristics were similar in both groups. Four patients were excluded from the analysis, because three of them died within 72 hrs and the fourth could not receive enteral nutrition and amino acid supplements for the first 10 days. Of the remaining 41 patients, length of care in the survivors was not different between groups (0.9 vs. 1.0 days/percent total body surface area for glutamine vs. control, respectively), positive blood culture was three times more frequent in control than in glutamine treatment (4.3 vs. 1.2 days/patient, p <.05), and Pseudomonas aeruginosa was detected in six patients on control and zero on glutamine (p <.05). Phagocytosis by polymorphonuclear cells was not different between groups. Mortality rate was significantly lower in glutamine than in control: intention to treat, two vs. 12 (p <.05); per protocol analysis, zero vs. eight (p <.01).


CONCLUSIONS
Enteral glutamine supplementation in adult burn patients reduces blood infection by a factor of three, prevents bacteremia with P. aeruginosa, and may decrease mortality rate. It has no effect on level of consciousness and does not appear to influence phagocytosis by circulating polymorphonuclear cells.
Garrel
Dominique
D
Burn Centre, Centre Hospitalier de l'Université de Montréal, Hôtel-Dieu, Quebec, Canada. dominique.garrel@umontreal.ca
Patenaude
Julie
J
Nedelec
Bernadette
B
Samson
Louise
L
Dorais
Judy
J
Champoux
Julie
J
D'Elia
Michele
M
Bernier
Jacques
J
D000328:Adult; D001481:Basal Metabolism; D002053:Burn Units; D002056:Burns / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D004311:Double-Blind Method; D004750:Enteral Nutrition; D005260:Female; D005973:Glutamine / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D018529:Nutritional Support; D010587:Phagocytosis / Q000187:drug effects; D011446:Prospective Studies
D005973:Glutamine