Efficacy and Safety of Glutamine-supplemented Parenteral Nutrition in Surgical ICU Patients: An American Multicenter Randomized Controlled Trial.
OBJECTIVE
To determine whether glutamine (GLN)-supplemented parenteral nutrition (PN) improves clinical outcomes in surgical intensive care unit (SICU) patients.


BACKGROUND
GLN requirements may increase with critical illness. GLN-supplemented PN may improve clinical outcomes in SICU patients.


METHODS
A parallel-group, multicenter, double-blind, randomized, controlled clinical trial in 150 adults after gastrointestinal, vascular, or cardiac surgery requiring PN and SICU care. Patients were without significant renal or hepatic failure or shock at entry. All received isonitrogenous, isocaloric PN [1.5 g/kg/d amino acids (AAs) and energy at 1.3× estimated basal energy expenditure]. Controls (n = 75) received standard GLN-free PN (STD-PN); the GLN group (n = 75) received PN containing alanyl-GLN dipeptide (0.5 g/kg/d), proportionally replacing AA in PN (GLN-PN). Enteral nutrition (EN) was advanced and PN weaned as indicated. Hospital mortality and infections were primary endpoints.


RESULTS
Baseline characteristics, days on study PN and daily macronutrient intakes via PN and EN, were similar between groups. There were 11 hospital deaths (14.7%) in the GLN-PN group and 13 deaths in the STD-PN group (17.3%; difference, -2.6%; 95% confidence interval, -14.6% to 9.3%; P = 0.66). The 6-month cumulative mortality was 31.4% in the GLN-PN group and 29.7% in the STD-PN group (P = 0.88). Incident bloodstream infection rate was 9.6 and 8.4 per 1000 hospital days in the GLN-PN and STD-PN groups, respectively (P = 0.73). Other clinical outcomes and adverse events were similar.


CONCLUSIONS
PN supplemented with GLN dipeptide was safe, but did not alter clinical outcomes among SICU patients.
*Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA †Center for Clinical and Molecular Nutrition, Emory University School of Medicine, Atlanta, GA ‡Emory University Hospital Nutrition and Metabolic Support Service, Atlanta, GA §Department of Surgery, Vanderbilt University Medical Center, Nashville, TN ¶Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA ||Department of Surgery, Virginia Technical Institute Carilion School of Medicine, Roanoke, VA **Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA ††Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA ‡‡Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA §§Department of Surgery, Miriam Hospital, Providence, RI ¶¶Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA ||||Department of Surgery, University of Wisconsin, Schools of Medicine and Public Health, Madison, WI ***Department of Surgery, Emory University School of Medicine, Atlanta, GA †††Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA; Hubert Department of Global Health Rollins School of Public Health, Emory University, Atlanta, GA ‡‡‡National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD §§§Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO.
Thomas R
TR
Ziegler
Addison K
AK
May
Gautam
G
Hebbar
Kirk A
KA
Easley
Daniel P
DP
Griffith
Nisha
N
Dave
Bryan R
BR
Collier
George A
GA
Cotsonis
Li
L
Hao
Traci
T
Leong
Amita K
AK
Manatunga
Eli S
ES
Rosenberg
Dean P
DP
Jones
Gregory S
GS
Martin
Gordon L
GL
Jensen
Harry C
HC
Sax
Kenneth A
KA
Kudsk
John R
JR
Galloway
Henry M
HM
Blumberg
Mary E
ME
Evans
Paul E
PE
Wischmeyer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005973:Glutamine / Q000008:administration & dosage*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010288:Parenteral Nutrition / Q000379:methods*; D057947:Parenteral Nutrition Solutions; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D014481:United States; D055815:Young Adult
D057947:Parenteral Nutrition Solutions; D005973:Glutamine