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Table 4 Relevant outcome parameters of included randomized studies of enteral glutamine supplementation in critically ill patients

From: Enteral glutamine supplementation in critically ill patients: a systematic review and meta-analysis

Study Methods Intervention Mortality, n (%)a Infections, n (%)b Hospital stay (days) ICU LOS (days)
  Score Dose (g/kg/day) Experimental Control Experimental Control Experimental Control Experimental Control
Type of feeding
Houdijk et al. [24] C. random: Yes >0.25 4/41 (9.8) 3/39 (7.7) 20/35 (57.1) 26/37 (70.2) 32.7 ± 17.1 33.0 ± 23.8 NA NA
ITT: No Altira Q (glutamine-enriched formula) vs. isonitrogenous control (added amino acids)
Blinding: Yes
10
Same volume of feeding received in both groups
Jones et al. [25] C. random: Yes 0.16 Hospital Hospital NA NA NA NA 11 (4–54) 16.5 (5–66)
ITT: No Protina Torre MP (Fresenius Kabi, Bad Homburg, Germany) + glutamine (10–15 g/day nitrogen) vs. isonitrogenous control (11–14 g/day nitrogen) 10/26 (38.5) 9/24 (37.5)
Blinding: Yes ICU ICU
8 9/26 (35) 9/24 (38)
6 months 6 months
12/26 (46) 10/24 (42)
Brantley and Pierce [26] C. random: Not sure 0.50 0/31 (0.0) 0/41 (0.0) NA NA 19.5 ± 8.8 20.8 ± 11.5 11.4 11.1
ITT: No Glutamine-supplemented enteral formula vs. standard formula (isonitrogenous) protein given 1.5 g/kg/day
Blinding: No
4
Hall et al. [27] C. random: Yes 0.27 Hospital Hospital 38/179 (21) 43/184 (23) 25 (16–42)c 30 (19–45)c 11 (7–19) (excluding deaths) 13 (8–19) (excluding deaths)
ITT: Yes Isocal (Nestlé Health Science, Lutry, Switzerland) + glutamine (66 g/day protein) vs. isonitrogenous formula Isocal + glycine (64 g/day protein) 24/179 (13) 23/184 (13)
Blinding: Yes ICU ICU
13 16/179 (9) 14/184 (8)
30 days 30 days
26/179 (15) 25/184 (14)
6 months 6 months
27/179 (15) 30/184 (16)
Hall et al. [27] C. random: Yes 0.27 7/76 (9) 6/78 (8) Sepsis Sepsis NA NA NA NA
Trauma subgroup ITT: Yes Isocal + glutamine (66 g/day protein) vs. isonitrogenous formula Isocal + glycine (64 g/day protein) 7/76 (9) 11/78 (14)
Blinding: Yes
13
Garrel et al. [28] C. random: Yes 0.28 2/21 (10) 12/24 (50) Positive blood cultures Positive blood cultures 33 ± 17 (16)d 29 ± 17 (19)d NA NA
ITT: yes Sandosource (Nestlé Health Science) + glutamine (2.15 g/kg/day protein) vs. Sandosource + amino acids (isonitrogenous), 1.97 g/kg/day protein 7/19 (37) 10/22 (45)
Blinding: Yes
11
Zhou et al. [29] C. random: Yes 0.35 0/20 0/20 2/20 (10) 6/20 (30) 67 ± 4 (20) 73 ± 6 (20) NA NA
ITT: No Ensure (NutriDrinks, Perivale, UK) + glutamine vs. Ensure + amino acids (isonitrogenous)
Blinding: Double-blind
8
Peng et al. [30] C. random: Not sure 0.5 NA NA NA NA 46.6 ± 12.9 (25) 55.7 ± 17.4 (23) NA NA
ITT: Yes Oral glutamine granules vs. placebo (isocaloric, isonitrogenous) 2.0 g/kg/day protein
Blinding: No
7
Luo et al.e [31] C. random: Not sure 0.32 ICU ICU NA NA NA NA 8.1 ± 0.4 (12) 6.9 ± 0.9 (9)
ITT: No Glutamine + IV saline + vs. Nutren (Nestlé Health Science) + 15 % Clinisol (Baxter Healthcare, Deerfield, IL, USA) (placebo) (isocaloric, isonitrogenous) 1/12 0 /9
Blinding: Double-blind 28 days 28 days
9 1.7 g/kg/d protein 1/12 0 /9
McQuiggan et al. [32] C. random: Not sure 0.5 (actual 0.4) IMPACT (Nestlé Health Science) + Glutasolve (Nestlé Health Science) via NJ tube (1.3 g/kg/day protein), bolus with H2O vs. Impact + protein supplements (isonitrogenous, isocaloric) 0.85 g/kg/day protein 0/10 2/10 (20) NA NA 32 ± 13.6 (10) 39.3 ± 33.6 (10) 4.8 ± 6.7 (10) 10.4 ± 6.2 (10)
ITT: Yes
Blinding: No
10
Pattanshetti et al. [33] C. random: Not sure Enteral isonitrogenous mixture + EN glutamine + “regular” nutrition vs. enteral isonitrogenous mixture + “regular” nutrition 0/15 2/15 Number of times positive blood cultures Number of times positive blood cultures 22.73 ± 9.13 39.73 ± 18.27 NA NA
ITT: Yes
Blinding: Single-blind (outcomes)
8 0.20 ± 0.41 0.73 ± 0.96
van Zanten et al. [14] C. random: Yes 0.28 (mean intake) glutamine, omega-3, antioxidant-enriched EN (experimental product) vs. isonitrogenous, isocaloric high-protein EN (Nutrison Advanced Protison; Nutricia Advanced Medical Nutrition, Amsterdam, the Netherlands) Hospital Hospital 80/152 (53) 78/149 (52) 38.2 ± 28.9 37.7 ± 27.5 23.7 ± 22.4 25.6 ± 24.0
ITT: Yes 38/152 (25) 33/149 (22)
Blinding: Double-blind ICU ICU
12 30/152 (20) 29/149 (20)
28 days 28 days
31/152 (20) 25/149 (17)
6 months 6 months
53/152 (35) 42/149 (29)
van Zanten et al. [14] trauma subgroup C. random: Yes 0.28 (mean intake) glutamine, omega-3, antioxidant-enriched EN (experimental product) vs. isonitrogenous, isocaloric high-protein EN (Nutrison Advanced Protison) Hospital Hospital 32/55 (58) 36/54 (67) 44.4 ± 31.2 39.8 ± 25.3 31.3 ± 30.3 32.5 ± 27.5
ITT: Yes 6/55 (11) 6/54 (11)
Blinding: Double-blind ICU ICU
12 5/55 (9) 6/54 (11)
28 days 28 days
4/55 (7) 2/54 (4)
6 months 6 months
8/55 (15) 59/54 (17)
  1. C. random concealed randomization median (range), EN enteral nutrition, ITT intent to treat, IV intravenous, NA not applicable, NJ nasojejunal, TPN total parenteral nutrition
  2. Data are presented as mean ± standard deviation or number (%), as appropriate
  3. aHospital mortality unless otherwise stated
  4. bNumber of patients with infections unless otherwise stated
  5. cMedian and range hence not included in meta-analysis (Hall et al. 2003 [27]; p = not significant)
  6. dSubgroup of patients, hence not included in the meta-analyses [28]
  7. eData from parenteral glutamine group not shown here