There is much discussion on this field, glutamine is recommended when critically ill patients need parenteral nutrition. We agree with this recommendation and use glutamine in our patients when parenteral nutrition is indicated.
I never used glutamine supplementation.
Recently the randomized trial of Andrews et al showed no effect on new infection and mortality (BMJ 2011).
Whereas a recent systematic review in critical care ( april 18) observed only A TREND ( p=.09 !), authors concluded "that glutamine supplementation shoud be continued" , in contrast with the results of their review!!
poor EBM
In patients with total parenteral nutrition we routinely give supplemental glutamin (0.3g/kg Glutamin, that means 0.5g/kg L-alanyl-L-Glutamin) because we use a all-in-one-solution without any glutamin.
Supplemental glutamin for ICU patients, where is the evidence?
In contrast, for outside ( home) prolonged ( more than X months) parenteral nutrition, supplemental glutamin may be used , even if abzsence of a controlled randomized trial...
Glutamine is the most abundant free amino acid in the body, but its stores are rapidly depleted during critical illness or injury, including burns. Critically ill patients often have decreased glutamine level on ICU admission, and low plasma glutamine levels are associated with increased mortality.
However, the recent REDOXS trial showed a dramatic increase in mortality rates with high doses of enteral and parenteral glutamine (0.6 g/kg per day). Even though there were more patients with three or more organ systems (including renal failure) failing in the glutamine group than in the control group, a strong trend toward increased mortality with glutamine remained after adjustment for this. In another study (van Zanten ARH et al. JAMA, 2014), high-protein enteral nutrition enriched with glutamine and ‘immune-modulating nutrients’ did not reduce infectious complications or improve other clinical endpoints versus standard high-protein enteral nutrition and may have been harmful as suggested by an increased adjusted mortality at 6 months. Therefore, it's necessary caution untill the mechanisms behind the harmful effects reported in the REDOXS study are better understood.
I complete agree with the N Bresolin analysis.
Futhremore, the recent systematic review and metaanalysis by Van Zahten ( Crit Care August 18, 2015) confirms the lack of glutamine usefullness, even if, the REDOXS data were not included in this recent analysis.
So we do not need Glutamine supplementation, moreover it seems to be deleterious.
Good bye, Glutamine supplementation
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