title: Enteral glutamine during active shock resuscitation is safe and enhances tolerance of enteral feeding.
abstract: BACKGROUND
  Feeding the hemodynamically unstable patient is increasingly practiced, yet few data exist on its safety. Because enteral glutamine is protective to the gut in experimental models of shock and improves clinical outcomes, it may benefit trauma patients undergoing shock resuscitation and improve tolerance if administered early. This pilot study aimed to evaluate gastrointestinal tolerance and safety of enteral feeding with glutamine, beginning during shock resuscitation in severely injured patients.
  
  
  METHODS
  In a prospective randomized trial, 20 patients were randomly assigned to either an enteral glutamine group (n = 10) or a control group (n = 10). Patients with severe trauma meeting standardized shock resuscitation criteria received enteral glutamine 0.5 g/kg/d during the first 24 hours of resuscitation and 10 days thereafter. Immune-enhancing diet began on postinjury day 1, with a target of 25 kcal/kg/d. Control patients received isonitrogenous whey powder plus immune-enhancing diet. Tolerance (vomiting, nasogastric output, diarrhea, and distention) was assessed throughout the study.
  
  
  RESULTS
  Glutamine was well tolerated and no adverse events occurred. Treated patients had significantly fewer instances of high nasogastric output (5 vs 23; p = .010), abdominal distention (3 vs 12; p = .021), and total instances of intolerance (8 vs 42; p = .011). Intensive care unit (ICU) and hospital length of stay were comparable. Control patients required supplemental parenteral nutrition (PN) to meet goals at day 7.
  
  
  CONCLUSIONS
  Enteral glutamine administered during active shock resuscitation and through the early postinjury period is safe and enhances gastrointestinal tolerance. A large clinical trial is warranted to determine if enteral glutamine administered to the hemodynamically unstable patient can reduce infectious morbidity and mortality.
authors.affiliation: Department of Surgery, University of Texas Medical School Houston, Houston, Texas, USA. MMcQuiggan@tmhs.org
authors.forename: Margaret
authors.initials: M
authors.lastname: McQuiggan
authors.forename: Rosemary
authors.initials: R
authors.lastname: Kozar
authors.forename: R Matthew
authors.initials: RM
authors.lastname: Sailors
authors.forename: Chul
authors.initials: C
authors.lastname: Ahn
authors.forename: Bruce
authors.initials: B
authors.lastname: McKinley
authors.forename: Frederick
authors.initials: F
authors.lastname: Moore
mesh_terms: D000328:Adult; D004750:Enteral Nutrition; D005260:Female; D005973:Glutamine / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay; D008297:Male; D009751:Nutritional Requirements; D010288:Parenteral Nutrition; D010865:Pilot Projects; D011446:Prospective Studies; D012449:Safety; D012769:Shock / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005973:Glutamine