Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-25T18:40:50.888Z Has data issue: false hasContentIssue false
  • English
  • Français

Glutamine in critical care: current evidence from systematic reviews

Published online by Cambridge University Press:  07 March 2007

Alison Avenell
Alison Avenell*
Affiliation:
Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
*
Corresponding author: Dr Alison Avenell, fax +44 1224 554580; email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Glutamine, the most abundant amino acid in the body, is thought to become conditionally essential in critical illness. Some of the important roles for glutamine are as a carrier for inter-organ N, a preferred fuel for enterocytes and cells of the immune system, a substrate for renal NH3 formation and a precursor for glutathione. Mechanisms by which glutamine could improve recovery include attenuating oxidant damage and inflammatory cytokine production, reducing gut bacterial translocation and improving N balance. The present systematic review has found trends to suggest that parenteral and enteral glutamine supplementation reduce mortality, the development of infection and organ failure in critical illness. Trials of parenteral nutrition containing glutamine with patients after elective surgery also suggest reduction of infection, but it is unlikely that glutamine-containing parenteral nutrition would be used for such patients. The evidence base is limited by the quality of the reported trials and the suggestion that there is publication bias, with trials suggesting reduced infection being more likely to be published.

Keywords

GlutamineRandomised controlled trialsSystematic reviewsMeta-analysesCritical illness
Type
BAPEN Symposium 4 on ‘Glutamine and antioxidants in critical care’
Information
Proceedings of the Nutrition Society , Volume 65 , Issue 3 , August 2006 , pp. 236 - 241
Copyright
Copyright © The Nutrition Society 2006

References

Brantley, S & Pierce, J (2000) Effects of enteral glutamine on trauma patients. Nutrition in Clinical Practice 15 S13.Google Scholar
Conejero, R, Bonet, A, Grau, T, Esteban, A, Mesejo, A, Montejo, JC, López, J & Acosta, JA (2002) Effect of glutamine-enriched enteral diet on intestinal permeability and infectious morbidity at 28 days in critically ill patients with systemic inflammatory response syndrome: a randomized, single-blind, prospective, multicenter study. Nutrition 18 716–721.CrossRefGoogle ScholarPubMed
Critical Care Connections Inc. (2005) Canadian clinical practice guidelines for nutrition support in the mechanically ventilated, critically ill adult patient. http://www.criticalcarenutrition.com/tableofcontents1.htm (accessed 16 December 2005).Google Scholar
de Beaux, AC, O'Riordain, MG, Ross, JA, Jodozi, L, Carter, DC & Fearon, KC (1998) Glutamine-supplemented total parenteral nutrition reduces blood mononuclear cell interleukin-8 release in severe acute pancreatitis. Nutrition 14 261–265.CrossRefGoogle ScholarPubMed
Déchelotte, P, Bleichner, G, Hasselmann, M, Dassonville, J, Allaouchiche, B, Czernichow, P & Rangaraj, J (2002) Improved clinical outcome in ICU patients receiving alanyl-glutamine (Dipeptiven) supplemented total parenteral nutrition (TPN). A French double-blind multicentre study. Clinical Nutrition 21, Suppl. 1–2Google Scholar
De-Souza, DA & Greene, LJ (2005) Intestinal permeability and systemic infections in critically ill patients: effect of glutamine. Critical Care Medicine 33 1125–1135.CrossRefGoogle ScholarPubMed
Eaton, S (2006) The biochemical basis of antioxidant therapy in critical illness. Proceedings of the Nutrition Society 65 242–249.CrossRefGoogle ScholarPubMed
Fuentes-Orozco, C, Anay-Prado, R, González-Ojeda, A, Arenas-Márquez, H, Cabrera-Pivaral, C, Cervantes-Guevara, G & Barrera-Zepeda, LM (2004) L-Alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis. Clinical Nutrition 23 13–21.CrossRefGoogle ScholarPubMed
Garrel, D, Patenaude, J, Nedelec, B, Samson, L, Dorais, J, Champoux, J, D'Elia, M & Bernier, J (2003) Decreased mortality and infectious morbidity in adult burn patients given enteral glutamine supplements: a prospective controlled, randomized clinical trial. Critical Care Medicine 31 2444–2449.Google Scholar
Goeters, C, Mertes, N, Wempe, C, Van Aken, H, Stehle, P & Bone, H-G (2002) Parenteral L-alanyl-L-glutamine improves 6-month outcome in critically ill patients. Critical Care Medicine 30 2032–2037.CrossRefGoogle ScholarPubMed
Griffiths, RD, Jones, C & Palmer, TE (1997) Six-month outcome of critically ill patients given glutamine-supplemented parenteral nutrition. Nutrition 13 295–302.Google ScholarPubMed
Hall, JC, Dobb, G, Hall, J, de Sousa, R, Brennan, L & McCauley, R (2003) A prospective randomized trial of enteral glutamine in critical illness. Intensive Care Medicine 29 1710–1716.CrossRefGoogle ScholarPubMed
Heyland, D & Dhaliwal, R (2005) Immunonutrition in the critically ill: from old approaches to new paradigms. Intensive Care Medicine 31 501–503.CrossRefGoogle ScholarPubMed
Higgins, JPT, Thompson, SG, Deeks, JJ & Altman, DG (2003) Measuring inconsistency in meta-analyses. British Medical Journal 327 557–560.CrossRefGoogle ScholarPubMed
Houdijk, AP, Rijnsburger, ER, Jansen, J, Wesdorp, RI, Weiss, JK, McCamish, MA, Teerlink, T, Meuwissen, SG, Haarman, HJ, Thijs, LG & Van Leeuwen, PA (1998) Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma. Lancet 352 772–776.Google Scholar
Jacobi, CA, Ordemann, J, Zuckermann, H, Döcke, W, Volk, HD & Müller, JM (1999) Einfluss von alanyl-glutamin bei der postoperativen totalen parenteralen ernahrung auf die morbiditat unter besonderer berucksichtigung der immunfunktion. Erste ergebnisse einer prospektiv randomisierten studie (The influence of alanyl-glutamine in postoperative total parenteral nutrition on immunologic functions and morbidity. Preliminary results of a prospective randomized trial). Zentralblatt für Chirurgie 124 199–205.Google ScholarPubMed
Jiang, ZM, Cao, JD, Zhu, XG, Zhao, WX, Yu, JC, Ma, EL, Wang, XR, Zhu, MW, Shu, H & Liu, YW (1999) The impact of alanyl-glutamine on clinical safety, nitrogen balance, intestinal permeability, and clinical outcome in postoperative patients: a randomized, double-blind, controlled study of 120 patients. Journal of Parenteral and Enteral Nutrition 23 S62–S66.Google Scholar
Jones, C, Palmer, TE & Griffiths, RD (1999) Randomized clinical outcome study of critically ill patients given glutamine-supplemented enteral nutrition. Nutrition 15 108–115.CrossRefGoogle ScholarPubMed
Klek, S, Kulig, J, Szczepanik, AM, Jedrys, J & Kolodziejczyk, P (2005) The clinical value of parenteral immunonutrition in surgical patients. Acta Chirurgica Belgica 105 175–179.Google Scholar
Melis, GC, ter Wengle, N, Boelens, PG & Van Leeuwen, PA (2004) Glutamine: recent developments in research on the clinical significance of glutamine. Current Opinion in Clinical Nutrition and Metabolic Care 7 59–70.Google Scholar
Mertes, N, Schulzki, C, Goeters, C, Winde, G, Benzing, S, Kuhn, KS, Van Aken, H, Stehle, P & Furst, P (2000) Cost containment through L-alanyl-L-glutamine supplemented total parenteral nutrition after major abdominal surgery: a prospective randomized double-blind controlled study. Clinical Nutrition 19 395–401.CrossRefGoogle ScholarPubMed
Neri, A, Mariani, F, Piccolomini, A, Testa, M, Vuolo, G & Di Cosmo, L (2001) Glutamine-supplemented total parenteral nutrition in major abdominal surgery. Nutrition 17 968–969.CrossRefGoogle ScholarPubMed
Nitta, H, Ikeda, K, Aoki, K, Otsuka, K, Sato, N, Ishida, K & Saito, K (2001) Effects of perioperative great amount of glutamine supplementation by enteral route on amino acids metabolism. Journal of Parenteral and Enteral Nutrition 25 S22.Google Scholar
Novak, F, Heyland, DK, Avenell, A, Drover, JW & Su, X (2002) Glutamine supplementation in serious illness: a systematic review of the evidence. Critical Care Medicine 30 2022–2029.CrossRefGoogle ScholarPubMed
Ockenga, J, Borchert, K, Rifai, K, Manns, MP & Bischoff, SC (2002) Effect of glutamine-enriched total parenteral nutrition in patients with acute pancreatitis. Clinical Nutrition 21 409–416.CrossRefGoogle ScholarPubMed
O'Riordain, MG, Fearon, KC, Ross, JA, Rogers, P, Falconer, JS, Bartolo, DC, Garden, OJ & Carter, DC (1994) Glutamine-supplemented total parenteral nutrition enhances T-lymphocyte response in surgical patients undergoing colorectal resection. Annals of Surgery 220 212–221.CrossRefGoogle ScholarPubMed
Powell-Tuck, J, Jamieson, CP, Bettany, GE, Obeid, O, Fawcett, HV, Archer, C & Murphy, DL (1999) A double blind, randomised, controlled trial of glutamine supplementation in parenteral nutrition. Gut 45 82–88.CrossRefGoogle ScholarPubMed
Simpson, F & Doig, GS (2005) Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle. Intensive Care Medicine 31 12–23.CrossRefGoogle Scholar
Singleton, KD, Serkova, N, Beckey, VE & Wischmeyer, PE (2005) Glutamine attenuates lung injury and improves survival after sepsis: role of enhanced heat shock protein expression. Critical Care Medicine 33 1206–1213.CrossRefGoogle ScholarPubMed
Spittler, A, Sautner, T, Gornikiewicz, A, Manhart, N, Oehler, R, Bergmann, M, Függer, R & Roth, E (2001) Postoperative glycyl-glutamine infusion reduces immunosuppression: partial prevention of the surgery induced decrease in HLA-DR expression of monocytes. Clinical Nutrition 20 37–42.CrossRefGoogle Scholar
Stehle, P, Zander, J, Mertes, N, Albers, S, Puchstein, C, Lawin, P & Furst, P (1989) Effect of parenteral glutamine peptide supplements on muscle glutamine loss and nitrogen balance after major surgery. Lancet i 231–233.CrossRefGoogle Scholar
Sterne, AC, Bradburn, MJ & Egger, M (2001) Meta-analysis in Stata™. In Systematic Reviews in Health Care, pp. 347–369 [Egger, M, Smith, GD and Altman, DG, editors]. London: BMJ Publishing Group.CrossRefGoogle ScholarPubMed
Tjäder, I, Rooyackers, O, Forsberg, A-M, Vesali, RF, Garlick, PJ & Wernerman, J (2004) Effects on skeletal muscle of intravenous glutamine supplementation to ICU patients. Intensive Care Medicine 30 266–275.CrossRefGoogle ScholarPubMed
Wischmeyer, PE, Lynch, J, Liedel, J, Wolfson, R, Riehm, J, Gottlieb, L & Kahana, M (2001) Glutamine administration reduces Gram-negative bacteremia in severely burned patients: a prospective, randomized, double-blind trial versus isonitrogenous control. Critical Care Medicine 29 2075–2080.Google Scholar
Ziegler, TR, Fernandez-Estivariz, C, Griffith, DP, Szeszycki, EE, Bazargan, N & Luo, M, et al. (2004) Parenteral nutrition supplemented with alanyl-glutamine dipeptide decreases infectious morbidity and improves organ function in critically ill post-operative patients: results of a double-blind, randomized, controlled pilot study. Journal of Parenteral and Enteral Nutrition 28 S11–S12.Google Scholar