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L-alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: the French controlled, randomized, double-blind, multicenter study.
Crit Care Med. 2006 Mar; 34(3):598-604.CC

Abstract

OBJECTIVE

Glutamine (Gln)-supplemented total parenteral nutrition (TPN) improves clinical outcome after planned surgery, but the benefits of Gln-TPN for critically ill (intensive care unit; ICU) patients are still debated.

DESIGN

Prospective, double-blind, controlled, randomized trial.

SETTING

ICUs in 16 hospitals in France.

PATIENTS

One-hundred fourteen ICU patients admitted for multiple trauma (38), complicated surgery (65), or pancreatitis (11).

INTERVENTIONS

Patients were randomized to receive isocaloric isonitrogenous TPN via a central venous catheter providing 37.5 kcal and 1.5 g amino acids.kg-1.day-1 supplemented with either L-alanyl-L-glutamine dipeptide (0.5 g.kg-1.day-1; Ala-Gln group, n=58) or L-alanine+L-proline (control group, n=56) over at least 5 days.

MEASUREMENTS AND MAIN RESULTS

Complicated clinical outcome was defined a priori by the occurrence of infectious complications (according to the criteria of the Centers for Disease Control and Prevention), wound complication, or death. The two groups were compared by chi-square test on an intention-to-treat basis. The two groups did not differ at inclusion for type and severity of injury (mean simplified acute physiology score II, 30 vs. 30.5; mean injury severity score, 44.9 vs. 42.3). Similar volumes of TPN were administered in both groups. Ala-Gln-supplemented TPN was associated with a lower incidence of complicated outcome (41% vs. 61%; p<.05), which was mainly due to a reduced infection rate per patient (mean, 0.45 vs. 0.71; p<.05) and incidence of pneumonia (10 vs. 19; p<.05). Early death rate during treatment and 6-month survival were not different. Hyperglycemia was less frequent (20 vs. 30 patients; p<.05) and there were fewer insulin-requiring patients (14 vs. 22; p<.05) in the Ala-Gln group.

CONCLUSIONS

TPN supplemented with Ala-Gln dipeptide in ICU patients is associated with a reduced rate of infectious complications and better metabolic tolerance.

Authors+Show Affiliations

Nutrition Unit, Rouen University Hospital (PD), Rouen, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16505644

Citation

Déchelotte, Pierre, et al. "L-alanyl-L-glutamine Dipeptide-supplemented Total Parenteral Nutrition Reduces Infectious Complications and Glucose Intolerance in Critically Ill Patients: the French Controlled, Randomized, Double-blind, Multicenter Study." Critical Care Medicine, vol. 34, no. 3, 2006, pp. 598-604.
Déchelotte P, Hasselmann M, Cynober L, et al. L-alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: the French controlled, randomized, double-blind, multicenter study. Crit Care Med. 2006;34(3):598-604.
Déchelotte, P., Hasselmann, M., Cynober, L., Allaouchiche, B., Coëffier, M., Hecketsweiler, B., Merle, V., Mazerolles, M., Samba, D., Guillou, Y. M., Petit, J., Mansoor, O., Colas, G., Cohendy, R., Barnoud, D., Czernichow, P., & Bleichner, G. (2006). L-alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: the French controlled, randomized, double-blind, multicenter study. Critical Care Medicine, 34(3), 598-604.
Déchelotte P, et al. L-alanyl-L-glutamine Dipeptide-supplemented Total Parenteral Nutrition Reduces Infectious Complications and Glucose Intolerance in Critically Ill Patients: the French Controlled, Randomized, Double-blind, Multicenter Study. Crit Care Med. 2006;34(3):598-604. PubMed PMID: 16505644.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - L-alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: the French controlled, randomized, double-blind, multicenter study. AU - Déchelotte,Pierre, AU - Hasselmann,Michel, AU - Cynober,Luc, AU - Allaouchiche,Bernard, AU - Coëffier,Moïse, AU - Hecketsweiler,Bernadette, AU - Merle,Véronique, AU - Mazerolles,Michel, AU - Samba,Désiré, AU - Guillou,Yves Marie, AU - Petit,Jean, AU - Mansoor,Odile, AU - Colas,Gabriel, AU - Cohendy,Robert, AU - Barnoud,Didier, AU - Czernichow,Pierre, AU - Bleichner,Gérard, PY - 2006/3/1/pubmed PY - 2006/4/11/medline PY - 2006/3/1/entrez SP - 598 EP - 604 JF - Critical care medicine JO - Crit Care Med VL - 34 IS - 3 N2 - OBJECTIVE: Glutamine (Gln)-supplemented total parenteral nutrition (TPN) improves clinical outcome after planned surgery, but the benefits of Gln-TPN for critically ill (intensive care unit; ICU) patients are still debated. DESIGN: Prospective, double-blind, controlled, randomized trial. SETTING: ICUs in 16 hospitals in France. PATIENTS: One-hundred fourteen ICU patients admitted for multiple trauma (38), complicated surgery (65), or pancreatitis (11). INTERVENTIONS: Patients were randomized to receive isocaloric isonitrogenous TPN via a central venous catheter providing 37.5 kcal and 1.5 g amino acids.kg-1.day-1 supplemented with either L-alanyl-L-glutamine dipeptide (0.5 g.kg-1.day-1; Ala-Gln group, n=58) or L-alanine+L-proline (control group, n=56) over at least 5 days. MEASUREMENTS AND MAIN RESULTS: Complicated clinical outcome was defined a priori by the occurrence of infectious complications (according to the criteria of the Centers for Disease Control and Prevention), wound complication, or death. The two groups were compared by chi-square test on an intention-to-treat basis. The two groups did not differ at inclusion for type and severity of injury (mean simplified acute physiology score II, 30 vs. 30.5; mean injury severity score, 44.9 vs. 42.3). Similar volumes of TPN were administered in both groups. Ala-Gln-supplemented TPN was associated with a lower incidence of complicated outcome (41% vs. 61%; p<.05), which was mainly due to a reduced infection rate per patient (mean, 0.45 vs. 0.71; p<.05) and incidence of pneumonia (10 vs. 19; p<.05). Early death rate during treatment and 6-month survival were not different. Hyperglycemia was less frequent (20 vs. 30 patients; p<.05) and there were fewer insulin-requiring patients (14 vs. 22; p<.05) in the Ala-Gln group. CONCLUSIONS: TPN supplemented with Ala-Gln dipeptide in ICU patients is associated with a reduced rate of infectious complications and better metabolic tolerance. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/16505644/L_alanyl_L_glutamine_dipeptide_supplemented_total_parenteral_nutrition_reduces_infectious_complications_and_glucose_intolerance_in_critically_ill_patients:_the_French_controlled_randomized_double_blind_multicenter_study_ L2 - https://dx.doi.org/10.1097/01.CCM.0000201004.30750.D1 DB - PRIME DP - Unbound Medicine ER -