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Monitoring the clinical introduction of a glutamine and antioxidant solution in critically ill trauma and burn patients.
Nutrition. 2008 Nov-Dec; 24(11-12):1123-32.N

Abstract

OBJECTIVE

Enteral glutamine supplementation and antioxidants have been shown to be beneficial in some categories of critically ill patients. This study investigated the impact on organ function and clinical outcome of an enteral solution enriched with glutamine and antioxidant micronutrients in patients with trauma and with burns.

METHODS

This was a prospective study of a historical control group including critically ill, burned and major trauma patients (n = 86, 40 patients with burns and 46 with trauma, 43 in each group) on admission to an intensive care unit in a university hospital (matching for severity, age, and sex). The intervention aimed to deliver a 500-mL enteral solution containing 30 g of glutamine per day, selenium, zinc, and vitamin E (Gln-AOX) for a maximum of 10 d, in addition to control treatment consisting of enteral nutrition in all patients and intravenous trace elements in all burn patients.

RESULTS

Patients were comparable at baseline, except for more inhalation injuries in the burn-Gln-AOX group (P = 0.10) and greater neurologic impairment in the trauma-Gln-AOX group (P = 0.022). Intestinal tolerance was good. The full 500-mL dose was rarely delivered, resulting in a low mean glutamine daily dose (22 g for burn patients and 16 g for trauma patients). In burn patients intravenous trace element delivery was superior to the enteral dose. The evolution of the Sequential Organ Failure Assessment score and other outcome variables did not differ significantly between groups. C-reactive protein decreased faster in the Gln-AOX group.

CONCLUSION

The Gln-AOX supplement was well tolerated in critically ill, injured patients, but did not improve outcome significantly. The delivery of glutamine below the 0.5-g/kg recommended dose in association with high intravenous trace element substitution doses in burn patients are likely to have blunted the impact by not reaching an efficient treatment dose. Further trials testing higher doses of Gln are required.

Authors+Show Affiliations

Department of Intensive Care Medicine & Burns Centre, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18692364

Citation

Soguel, Ludivine, et al. "Monitoring the Clinical Introduction of a Glutamine and Antioxidant Solution in Critically Ill Trauma and Burn Patients." Nutrition (Burbank, Los Angeles County, Calif.), vol. 24, no. 11-12, 2008, pp. 1123-32.
Soguel L, Chioléro RL, Ruffieux C, et al. Monitoring the clinical introduction of a glutamine and antioxidant solution in critically ill trauma and burn patients. Nutrition. 2008;24(11-12):1123-32.
Soguel, L., Chioléro, R. L., Ruffieux, C., & Berger, M. M. (2008). Monitoring the clinical introduction of a glutamine and antioxidant solution in critically ill trauma and burn patients. Nutrition (Burbank, Los Angeles County, Calif.), 24(11-12), 1123-32. https://doi.org/10.1016/j.nut.2008.05.024
Soguel L, et al. Monitoring the Clinical Introduction of a Glutamine and Antioxidant Solution in Critically Ill Trauma and Burn Patients. Nutrition. 2008 Nov-Dec;24(11-12):1123-32. PubMed PMID: 18692364.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Monitoring the clinical introduction of a glutamine and antioxidant solution in critically ill trauma and burn patients. AU - Soguel,Ludivine, AU - Chioléro,René L, AU - Ruffieux,Christiane, AU - Berger,Mette M, Y1 - 2008/08/09/ PY - 2008/01/23/received PY - 2008/05/20/revised PY - 2008/05/23/accepted PY - 2008/8/12/pubmed PY - 2009/1/30/medline PY - 2008/8/12/entrez SP - 1123 EP - 32 JF - Nutrition (Burbank, Los Angeles County, Calif.) JO - Nutrition VL - 24 IS - 11-12 N2 - OBJECTIVE: Enteral glutamine supplementation and antioxidants have been shown to be beneficial in some categories of critically ill patients. This study investigated the impact on organ function and clinical outcome of an enteral solution enriched with glutamine and antioxidant micronutrients in patients with trauma and with burns. METHODS: This was a prospective study of a historical control group including critically ill, burned and major trauma patients (n = 86, 40 patients with burns and 46 with trauma, 43 in each group) on admission to an intensive care unit in a university hospital (matching for severity, age, and sex). The intervention aimed to deliver a 500-mL enteral solution containing 30 g of glutamine per day, selenium, zinc, and vitamin E (Gln-AOX) for a maximum of 10 d, in addition to control treatment consisting of enteral nutrition in all patients and intravenous trace elements in all burn patients. RESULTS: Patients were comparable at baseline, except for more inhalation injuries in the burn-Gln-AOX group (P = 0.10) and greater neurologic impairment in the trauma-Gln-AOX group (P = 0.022). Intestinal tolerance was good. The full 500-mL dose was rarely delivered, resulting in a low mean glutamine daily dose (22 g for burn patients and 16 g for trauma patients). In burn patients intravenous trace element delivery was superior to the enteral dose. The evolution of the Sequential Organ Failure Assessment score and other outcome variables did not differ significantly between groups. C-reactive protein decreased faster in the Gln-AOX group. CONCLUSION: The Gln-AOX supplement was well tolerated in critically ill, injured patients, but did not improve outcome significantly. The delivery of glutamine below the 0.5-g/kg recommended dose in association with high intravenous trace element substitution doses in burn patients are likely to have blunted the impact by not reaching an efficient treatment dose. Further trials testing higher doses of Gln are required. SN - 0899-9007 UR - https://www.unboundmedicine.com/medline/citation/18692364/Monitoring_the_clinical_introduction_of_a_glutamine_and_antioxidant_solution_in_critically_ill_trauma_and_burn_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0899-9007(08)00272-4 DB - PRIME DP - Unbound Medicine ER -