Early ReportRandomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma
Introduction
Despite improvements in diagnostic and therapeutic strategies, infection remains a serious problem in severely injured patients.1 These infections are thought to be related to decreased immune function and translocation of gram-negative bacteria from the gut.2, 3 Glutamine deficiency may contribute to both of these processes since glutamine is the preferred respiratory fuel for both lymphocytes and enterocytes.4, 5
In animals with gut injury, dietary supplementation with glutamine reduces atrophy of the intestinal mucosa and bacterial translocation.6, 7, 8 In human beings, glutamine-enriched nutrition reduces clinical infection in bone-marrow-transplant recipients and maintains intestinal integrity in patients on parenteral nutrition.9, 10
Glutamine depletion occurs in critically injured patients, and may contribute to the high rate of infection.11 In this trial we investigated the effect of glutamine-supplemented enteral nutrition on infectious morbidity in patients with multiple trauma.
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Patients and methods
The study was approved by the Council for Medical Research of the Netherlands Organisation for Scientific Research and by the review board of our institute. Informed consent was obtained from the patients or their closest relative.
Results
Between January, 1992, and January, 1996, 80 patients with multiple trauma entered the study. The flow of patients is shown in the trial profile (figure 1). On admission there were no demographic differences between patient groups. The type of injury and surgical procedures patients had were similar in both groups (table 1). 12 patients were fed for less than 5 days. Within the 15 day study period three patients died from brain injuries (two glutamine, one control) and one patient died of
Discussion
We found that glutamine-enriched enteral nutrition reduced the number of pneumonia, bacteraemia and septic events in severely injured patients. The groups had similar demographics, Injury Severity Scores, APACHE II scores, types of injury, and number and types of operations. Furthermore, there were no differences in nutritional variables such as calculated basal energy expenditure, number of days on enteral nutrition, and daily caloric intake between the groups.
In trauma patients with similar
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