Glutamine: role in critical illness and ongoing clinical trials.
OBJECTIVE
This review will assess recent clinical and mechanistic data examining glutamine's ability to reduce morbidity and mortality in critical illness.


RESULTS
Updated metaanalysis data reveal a significant benefit of glutamine supplementation on mortality, length of stay, and infectious morbidity in critical illness. Recent data support glutamine's use in critically ill patients requiring parenteral nutrition and new data reveal safety and efficacy in head-injured patients. Further, new findings on glutamine's beneficial effect on insulin resistance in critical illness will be reviewed. Recent laboratory data have clarified a number of key mechanistic pathways by which glutamine may improve outcome in critical illness.


CONCLUSIONS
Severe glutamine deficiencies occur rapidly in critical illness. The magnitude of glutamine deficiency is correlated with ICU mortality. Further, metaanalysis reveals glutamine reduces morbidity and mortality in critical illness. It is likely that our new understanding of the molecular pathways by which glutamine acts will lead to insight on how best to utilize glutamine as a nutritional therapy. Presently, randomized, multicenter clinical trials utilizing glutamine as both nutritional replacement and pharmacologic intervention, independent of nutritional needs, are ongoing.
Wischmeyer
Paul E
PE
Department of Anesthesiology, University of Colorado Health Sciences Center, Denver, Colorado, USA. paul.wischmeyer@uchsc.edu
D002986:Clinical Trials as Topic; D006259:Craniocerebral Trauma / Q000188:drug therapy / Q000378:metabolism; D016638:Critical Illness / Q000628:therapy*; D005973:Glutamine / Q000008:administration & dosage / Q000172:deficiency*; D006360:Heat-Shock Proteins / Q000096:biosynthesis; D006801:Humans; D010288:Parenteral Nutrition
D006360:Heat-Shock Proteins; D005973:Glutamine