Glutamine Improves Outcomes in Burn Patients
Laurie Barclay, MD
Oct. 24, 2003 — Enteral glutamine supplements reduce blood infections and mortality in burn patients, according to the results of a prospective, controlled, randomized trial published in the October issue of Critical Care Medicine.
"Enteral glutamine supplements have been shown to reduce infectious morbidity in trauma patients, but their effect on burn patients is not known," write Dominique Garrel, from the University of Montreal in Quebec, Canada, and colleagues.
In this double-blinded study, 45 adults with severe burns were randomized to receive either glutamine or an isonitrogenous control mixture until complete healing occurred. Four patients were excluded from the analysis, three of whom died within 72 hours and one who could not receive enteral nutrition and amino acid supplements for the first 10 days.
In the remaining 41 patients, blood cultures were positive on 4.3 days per patient in the control group and on 1.2 days per patient in the glutamine group (P < .05). Six patients in the control group and none in the glutamine group had positive cultures for Pseudomonas aeruginosa (P < .05).
Mortality was significantly lower in the glutamine group than in the control group. By intention-to-treat analysis, there were two deaths vs. 12 deaths (P < .05), and by protocol analysis, there were no deaths vs. eight deaths (P < .01), respectively.
Phagocytosis by circulating polymorphonuclear cells was similar in both groups, as was length of care in the survivors (0.9 days/percentage of total body surface area for the glutamine group and 1.0 days/percentage of total body surface area for the control group).
"Enteral glutamine supplementation in adult burn patients reduces blood infection by a factor of three, prevents bacteremia with P. aeruginosa, and may decrease mortality rate," the authors write. "It has no effect on level of consciousness and does not appear to influence phagocytosis by circulating polymorphonuclear cells."
The Medical Research Council of Canada and the Fondation des Pompiers du Québec pour les Grands Brûlés helped support this study.
In an accompanying editorial, Jean-Charles Preiser, MD, PhD, from the University Hospital of Liege in Belgium, and Jan Wernerman, MD, PhD, from the Karolinska Institute in Sweden, ask why glutamine is "a life-saving nutrient."
Possible mechanisms include "shorter post-injury catabolism, altered immune response (increased T-lymphocyte response), decreased interleukin-8 release, and increased antioxidant defenses — muscle glutathione and plasma taurine."
Crit Care Med. 2003;31:2444-2449, 2555-2556