Role of parenteral glutamine supplementation on patient outcome in the surgical ICU

Introduction

During the excessive organ/tissue demand of glutamine (Gln) in episodes of stress following major surgery, endogenous Gln production may not be sufficient to meet the increased requirements. The aim of the study was to evaluate the effect of parenteral Gln supplementation on the outcome of surgical cancer patients after major surgery [1].

Methods

The study was performed on 40 adult patients admitted to the surgical ICU at the National Cancer Institute requiring total parenteral nutrition (TPN) for at least 5 days. Patients were assigned to two groups: control group, 20 patients received nutritional support as the usual protocol; and Gln group, 20 patients received nutritional support as the usual protocol + dipeptiven 300 mg/day for 7 days. Standard vitamins, trace elements, electrolytes and insulin therapy were supplied. The rate of infections, ICU and total hospital lengths of stay, severe hyperglycemia and days of mechanical ventilation were recorded.

Results

There were no differences between groups according to the demographic data, metabolic and nutritional parameters and the numbers of diabetic patients. There was also no difference in the duration of TPN. The incidence of pneumonia, surgical wound infection, sepsis, urinary or intravenous catheter infection were significantly lower in the Gln group compared with the control group. The days of mechanical ventilation among ventilated patients and the ICU length of stay were significantly lower in the Gln group compared with the control group. The nitrogen balance was more negative in control patients than in Gln-supplemented patients (the difference was insignificant). Hyperglycemia episodes were significantly lower and easy controlled in the Gln group. Total plasma amino acid concentrations and the Gln plasma level increased about 40% in patients receiving Gln supplementation. The number of adverse events per patient was significantly lower in the Gln group (2.1 vs. 2.9, P < 0.01).

Conclusion

Parenteral Gln-supplemented TPN reduces the clinical complications of surgical patients, mainly through a lower incidence of pneumonia and better metabolic tolerance. This forms a strong rationale for the use of Gln-supplemented regimens for surgical ICU patients.