title: When Is It Appropriate to Use Glutamine in Critical Illness?
abstract: Glutamine is a nonessential amino acid, which under trauma or critical illness can become essential. A number of historic small single-center randomized controlled trials (RCTs) have demonstrated positive treatment effects on clinical outcomes with glutamine supplementation. Meta-analyses based on these trials demonstrated a significant reduction in hospital mortality, intensive care unit (ICU) length of stay (LOS), and hospital LOS with intravenous (IV) glutamine. Similar results were not noted in 2 large multicenter RCTs (REDOXS and MetaPlus) assessing the efficacy of glutamine supplementation in ventilated ICU patients. The REDOXS trial of 40 ICUs randomized 1223 ventilated ICU patients to glutamine (IV and enteral), antioxidants, both glutamine and antioxidants, or placebo. The main conclusions were a trend toward increased 28-day mortality and significant increased hospital and 6-month mortality in those who received glutamine. The MetaPlus trial of 14 ICUs, which randomized 301 ventilated ICU patients to glutamine-enriched enteral vs an isocaloric diet, noted increased 6-month mortality in the glutamine-supplemented group. Newer RCTs have focused on specific populations and have demonstrated benefits in burn and elective surgery patients with glutamine supplementation. Whether larger studies will confirm these findings is yet to be determined. Recent American Society for Parenteral and Enteral Nutrition guidelines recommend that IV and enteral glutamine should not be used in the critical care setting based on the moderate quality of evidence available. We agree with these recommendations and would encourage larger multicenter studies to evaluate the risks and benefits of glutamine in burn and elective surgery patients.
authors.affiliation: Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA mundi.manpreet@mayo.edu.
authors.forename: Manpreet S
authors.initials: MS
authors.lastname: Mundi
authors.affiliation: Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Meera
authors.initials: M
authors.lastname: Shah
authors.affiliation: Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA Division of Gastroenterology, Hepatology, Nutrition, University of Louisville School of Medicine, Louisville, Kentucky, USA.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Hurt
mesh_terms: D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D019587:Dietary Supplements; D004750:Enteral Nutrition; D005973:Glutamine / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial
chemical_list: D005973:Glutamine
keywords: critical care; critical illness; glutamine; nutrition; nutritional support; parenteral nutrition