A prospective randomized trial of enteral glutamine in critical illness.

Objective: To assess the influence of enteral glutamine on the incidence of severe sepsis and death in critically ill patients. Design: This two-armed clinical trial was triple blind (patients, attending staff, research nurse). Setting: The 10 bed general ICU at Royal Perth Hospital, Western Australia. Patients: This trial evaluated 363 patients requiring mechanical ventilation (median APACHE II score=14); of these, 85 had trauma. Intervention: The intervention solution contained 20 g/l glutamine and the control solution was isojoulic and isonitrogenous. Measurements and Results: The groups had similar characteristics at baseline, and they also received equivalent amounts of protein and energy. Patients in the glutamine group received a median of 19 g/glutamine per day and 91% (332 of 363) of the patients were fed via a nasogastric tube (median duration=10 days). The outcomes were similar in the two groups: (a) death within 6 months: glutamine group 15% (27 of 179) vs control group 16% (30 of 184); p=0.75; relative risk, 0.95 (95% confidence interval, 0.71-1.28); and (b) severe sepsis: glutamine group 21% (38 of 179) vs control group 23% (43 of 184); p=0.62; relative risk, 0.94 (95% confidence interval, 0.72-1.22). There was also no discernable difference in the secondary outcomes relating to infections, febrile period, antimicrobial therapy, and consumption of inotropes. Conclusion: This clinical trial did not support the use of enteral glutamine supplements in similar cohorts of critically ill patients. [ABSTRACT FROM AUTHOR]

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