title: Parenteral glutamine supplementation in critical illness: a systematic review.
abstract: BACKGROUND
  The potential benefit of parenteral glutamine (GLN) supplementation has been one of the most commonly studied nutritional interventions in the critical care setting. The aim of this systematic review was to incorporate recent trials of traditional parenteral GLN supplementation in critical illness with previously existing data.
  
  
  METHODS
  All randomized controlled trials of parenterally administered GLN in critically ill patients conducted from 1997 to 2013 were identified. Studies of enteral GLN only or combined enteral/parenteral GLN were excluded. Methodological quality of studies was scored and data was abstracted by independent reviewers.
  
  
  RESULTS
  A total of 26 studies involving 2,484 patients examining only parenteral GLN supplementation of nutrition support were identified in ICU patients. Parenteral GLN supplementation was associated with a trend towards a reduction of overall mortality (relative risk (RR) 0.88, 95% confidence interval (CI) 0.75, 1.03, P = 0.10) and a significant reduction in hospital mortality (RR 0.68, 95% CI 0.51, 0.90, P = 0.008). In addition, parenteral GLN was associated with a strong trend towards a reduction in infectious complications (RR 0.86, 95% CI 0.73, 1.02, P = 0.09) and ICU length of stay (LOS) (WMD -1.91, (95% CI -4.10, 0.28, P = 0.09) and significant reduction in hospital LOS (WMD -2.56, 95% CI -4.71, -0.42, P = 0.02). In the subset of studies examining patients receiving parenteral nutrition (PN), parenteral GLN supplementation was associated with a trend towards reduced overall mortality (RR 0.84, 95% CI 0.71, 1.01, P = 0.07).
  
  
  CONCLUSIONS
  Parenteral GLN supplementation given in conjunction with nutrition support continues to be associated with a significant reduction in hospital mortality and hospital LOS. Parenteral GLN supplementation as a component of nutrition support should continue to be considered to improve outcomes in critically ill patients.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Wischmeyer
authors.forename: Rupinder
authors.initials: R
authors.lastname: Dhaliwal
authors.forename: Michele
authors.initials: M
authors.lastname: McCall
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Ziegler
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D003422:Critical Care; D005973:Glutamine / Q000008:administration & dosage*; D017052:Hospital Mortality; D006801:Humans; D007239:Infections / Q000150:complications; D007902:Length of Stay; D009026:Mortality; D010288:Parenteral Nutrition; D016896:Treatment Outcome
chemical_list: D005973:Glutamine
references.citation: Stat Med. 2008 Feb 28;27(5):746-63
references.pmid: 17592831
references.citation: JPEN J Parenter Enteral Nutr. 2008 Jul-Aug;32(4):389-402
references.pmid: 18596310
references.citation: Gut. 1999 Jul;45(1):82-8
references.pmid: 10369709
references.citation: Crit Care Med. 2002 Sep;30(9):2032-7
references.pmid: 12352037
references.citation: Crit Care Med. 2006 Mar;34(3):598-604
references.pmid: 16505644
references.citation: J Nutr. 2001 Sep;131(9 Suppl):2543S-9S; discussion 2550S-1S
references.pmid: 11533310
references.citation: Curr Opin Gastroenterol. 2008 Mar;24(2):190-7
references.pmid: 18301270
references.citation: World J Crit Care Med. 2013 Feb 04;2(1):4-8
references.pmid: 24701410
references.citation: Crit Care Med. 2001 Nov;29(11):2075-80
references.pmid: 11700398
references.citation: Intensive Care Med. 2001 Jan;27(1):84-90
references.pmid: 11280678
references.citation: Acta Anaesthesiol Scand. 2011 Aug;55(7):812-8
references.pmid: 21658010
references.citation: Stat Med. 2002 Jun 15;21(11):1539-58
references.pmid: 12111919
references.citation: Clin Nutr. 2004 Feb;23(1):13-21
references.pmid: 14757388
references.citation: Nutrition. 2008 Jun;24(6):522-7
references.pmid: 18367379
references.citation: Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2007 Aug;19(8):481-4
references.pmid: 17708846
references.citation: Crit Care Med. 2008 Jun;36(6):1707-13
references.pmid: 18496372
references.citation: Curr Opin Clin Nutr Metab Care. 2013 Mar;16(2):182-6
references.pmid: 23324900
references.citation: Crit Care Med. 2002 Sep;30(9):2022-9
references.pmid: 12352035
references.citation: Clin Nutr. 2008 Apr;27(2):297-306
references.pmid: 18258342
references.citation: Crit Care Med. 2007 Sep;35(9 Suppl):S545-52
references.pmid: 17713407
references.citation: Crit Care. 2010;14(6):R233
references.pmid: 21184675
references.citation: Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2006 Oct;18(10):616-8
references.pmid: 17038253
references.citation: Eur J Clin Nutr. 2007 Dec;61(12):1429-34
references.pmid: 17311061
references.citation: N Engl J Med. 2013 Apr 18;368(16):1489-97
references.pmid: 23594003
references.citation: JPEN J Parenter Enteral Nutr. 2008 Jul-Aug;32(4):403-11
references.pmid: 18596311
references.citation: Burns. 2013 Jun;39(4):565-70
references.pmid: 23313017
references.citation: Nutrition. 1997 Apr;13(4):295-302
references.pmid: 9178278
references.citation: Crit Care Med. 2009 Dec;37(12):3114-9
references.pmid: 19789447
references.citation: Crit Care Med. 1996 Apr;24(4):575-83
references.pmid: 8612406
references.citation: Q J Exp Physiol. 1985 Oct;70(4):473-89
references.pmid: 3909197
references.citation: Crit Care Med. 2011 Jun;39(6):1263-8
references.pmid: 21336131
references.citation: World J Gastroenterol. 2006 Dec 14;12(46):7537-41
references.pmid: 17167847
references.citation: Clin Nutr. 2013 Apr;32(2):213-23
references.pmid: 23196117
references.citation: Nutrition. 2002 Jul-Aug;18(7-8):546-52
references.pmid: 12093428
references.citation: Nutr Rev. 2005 Feb;63(2):65-9
references.pmid: 15762090
references.citation: BMJ. 2011 Mar 17;342:d1542
references.pmid: 21415104
references.citation: Nan Fang Yi Ke Da Xue Xue Bao. 2008 Jan;28(1):129-31
references.pmid: 18227044
references.citation: Anesth Analg. 2009 Aug;109(2):502-5
references.pmid: 19608826
references.citation: Clin Sci (Lond). 2012 Jun;122(12):591-7
references.pmid: 22248298