Intestinal permeability and systemic infections in critically ill patients: effect of glutamine.
OBJECTIVE
This article provides a critical review of the evidence indicating that an increase in intestinal permeability is associated with the installation of bacteremia, sepsis, and the multiple organ failure syndrome and that glutamine in pharmacologic doses reduces the acute increase of intestinal permeability and the infection frequency in critically ill patients.


METHODS
All studies published until December 2004 about intestinal permeability, bacterial translocation, and glutamine were located by search of PubMed and Web of Science. The reference lists of review articles and primary publications were also examined to identify references not detected in the computer search.


METHODS
Clinical and experimental studies investigating the correlation between intestinal permeability, bacterial translocation, and frequency of infections, associated or not with the effect of glutamine administration.


METHODS
Information regarding patient population, experimental design, glutamine doses and routes of administration, nutritional therapy prescribed, methods used to assess intestinal permeability, metabolic variables, and the frequency of infections were obtained from the primary literature.


RESULTS
Intestinal permeability is increased in critically ill patients. The results have not always been consistent, but the studies whose results support the association between intestinal permeability and systemic infections have had better design and more appropriate controls. The administration of glutamine by the intravenous or oral route and at the doses recommended before or immediately after surgery, burns, or the administration of parenteral nutrition has a protective effect that prevents or reduces the intensity of the increase in intestinal permeability. Glutamine reduces the frequency of systemic infections and may also reduce the translocation of intestinal bacteria and toxins, but this has not been demonstrated.


CONCLUSIONS
Glutamine administration improves the prognosis of critically ill patients presumably by maintaining the physiologic intestinal barrier and by reducing the frequency of infections.
De-Souza
Daurea A
DA
Department of Internal Medicine, Faculty of Medicine, Federal University of Uberlândia (DADS), Uberlândia, MG, Brazil.
Greene
Lewis J
LJ
D018988:Bacterial Translocation / Q000187:drug effects*; D003422:Critical Care; D005973:Glutamine / Q000008:administration & dosage / Q000378:metabolism / Q000627:therapeutic use; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism*; D009102:Multiple Organ Failure / Q000188:drug therapy* / Q000378:metabolism; D010539:Permeability / Q000187:drug effects*; D018746:Systemic Inflammatory Response Syndrome / Q000188:drug therapy* / Q000378:metabolism
D005973:Glutamine