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Ann Surg. 2016 Apr;263(4):646-55. doi: 10.1097/SLA.0000000000001487.

Efficacy and Safety of Glutamine-supplemented Parenteral Nutrition in Surgical ICU Patients: An American Multicenter Randomized Controlled Trial.

Author information

1
*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.

Abstract

OBJECTIVE:

To determine whether glutamine (GLN)-supplemented parenteral nutrition (PN) improves clinical outcomes in surgical intensive care unit (SICU) patients.

SUMMARY BACKGROUND DATA:

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.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00248638.

PMID:
26501700
PMCID:
PMC4877187
DOI:
10.1097/SLA.0000000000001487
[Indexed for MEDLINE]
Free PMC Article

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