A randomized trial of intravenous glutamine supplementation in trauma ICU patients |
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Authors: | Jon Pérez-Bárcena Pedro Marsé Arturo Zabalegui-Pérez Esther Corral Rubén Herrán-Monge María Gero-Escapa Mercedes Cervera Juan Antonio Llompart-Pou Ignacio Ayestarán Joan Maria Raurich Antonio Oliver Antonio Buño Abelardo García de Lorenzo Guiem Frontera |
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Affiliation: | 1. Intensive Care Department, Son Espases University Hospital, Crta Valldemossa 79, 07010, Palma, Spain 2. Intensive Care Department, Burgos University Hospital, Burgos, Spain 3. Intensive Care Department, Santiago Apóstol Hospital, Vitoria, Spain 4. Intensive Care Department, Río Hortega University Hospital, Valladolid, Spain 5. Pharmacy Department, Son Espases University Hospital, Palma, Spain 6. Microbiology Department, Son Espases University Hospital, Palma, Spain 7. Laboratory Medicine Department, La Paz University Hospital, Madrid, Spain 8. Intensive Care Department, La Paz University Hospital, Madrid, Spain 9. Investigation Unit, Son Espases University Hospital, Palma, Spain
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Abstract: | Purpose To evaluate the effect of the intravenous (i.v.) l-alanyl-l-glutamine dipeptide supplementation during 5 days on clinical outcome in trauma patients admitted to the intensive care unit (ICU). Methods This was a prospective, randomized, double-blind, multicenter trial. Glutamine was not given as a component of nutrition but as an extra infusion. The primary outcome variable was the number of new infections within the first 14 days. Results We included 142 patients. There were no differences between groups in baseline characteristics. Up to 62 % of the patients in the placebo group and 63 % in the treatment group presented confirmed infections (p = 0.86). ICU length of stay was 14 days in both groups (p = 0.54). Hospital length of stay was 27 days in the placebo group and 29 in the treatment group (p = 0.88). ICU mortality was 4.2 % in both groups (p = 1). Sixty percent of the patients presented low glutamine levels before randomization. At the end of the treatment (6th day), 48 % of the patients maintained low glutamine levels (39 % of treated patients vs. 57 % in the placebo group). Patients with low glutamine levels at day 6 had more number of infections (58.8 vs. 80.9 %; p = 0.032) and longer ICU (9 vs. 20 days; p < 0.01) and hospital length of stay (24 vs. 41 days; p = 0.01). Conclusions There was no benefit with i.v. l-alanyl-l-glutamine dipeptide supplementation (0.5 g/kg body weight/day of the dipeptide) during 5 days in trauma patients admitted to the ICU. The i.v. glutamine supplementation was not enough to normalize the plasma glutamine levels in all patients. Low plasma glutamine levels at day 6 were associated with a worse outcome. |
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