CI: Supplemental Intravenous Glutamine (2011)

CI: Supplemental Intravenous Glutamine (2011)

• Intervention
  In adult patients who are critically ill, does intravenous (IV) glutamine impact mortality?

  • Conclusion

    Based only on adequately powered studies, glutamine (Gln)-supplemented parenteral nutrition (PN) is unlikely to reduce intensive care unit (ICU) mortality in adult critically ill patients.
     

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In adult patients who are critically ill, does intravenous (IV) glutamine impact mortality?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Cai G, Yan J, Zhang Z, Yu Y. Immunomodulatory effects of glutamine enriched nutritional support in elderly patients with severe sepsis: A prospective, randomized, controlled study. J Organ Dysfunction. 2008, 4: 31-37.
      • Déchelotte P, Hasselmann M, Cynober L, Allaouchiche B, Coëffier M, Hecketsweiler B, Merle V, Mazerolles M, Samba D, Guillou YM, Petit J, Mansoor O, Colas G,Cohendy R, Barnoud D, Czernichow P, Bleichner G. L-alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: The French controlled, randomized, double-blind, multicenter study. Crit Care Med. 2006 Mar; 34(3): 598-604.
      • Estívariz CF, Griffith DP, Luo M, Szeszycki EE, Bazargan N, Dave N, Daignault NM,Bergman GF, McNally T, Battey CH, Furr CE, Hao L, Ramsay JG, Accardi CR, CotsonisGA, Jones DP, Galloway JR, Ziegler TR. Efficacy of parenteral nutrition supplemented with glutamine dipeptide to decrease hospital infections in critically ill surgical patients. JPEN J Parenter Enteral Nutr. 2008 Jul-Aug; 32 (4): 389-402.
      • Fuentes-Orozco C, Anaya-Prado R, González-Ojeda A, Arenas-Márquez H,Cabrera-Pivaral C, Cervantes-Guevara G, Barrera-Zepeda LM. L-alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis. Clin Nutr. 2004 Feb; 23(1): 13-21.
      • Fuentes-Orozco C, Cervantes-Guevara G, Muciño-Hernández I, López-Ortega A,Ambriz-González G, Gutiérrez-de-la-Rosa JL, Gómez-Herrera E, Hermosillo-Sandoval JM, González-Ojeda A. L-alanyl-L-glutamine-supplemented parenteral nutrition decreases infectious morbidity rate in patients with severe acute pancreatitis. J Parenter Enteral Nutr. 2008 Jul-Aug; 32 (4): 403-411.
      • Goeters C, Wenn A, Mertes N, Wempe C, Van Aken H, Stehle P, Bone HG. Parenteral L-alanyl-L-glutamine improves SIX-month outcome in critically ill patients. Crit Care Med. 2002 Sep; 30 (9): 2,032-2,037.
      • Griffiths RD, Allen KD, Andrews FJ, Jones C. Infection, multiple organ failure, and survival in the intensive care unit: Influence of glutamine-supplemented parenteral nutrition on acquired infection. Nutrition. 2002 Jul-Aug; 18(7-8): 546-552.
      • Powell-Tuck J, Jamieson CP, Bettany GE, Obeid O, Fawcett HV, Archer C, Murphy DL. A double-blind, randomized, controlled trial of glutamine supplementation in parenteral nutrition. Gut. 1999 Jul; 45 (1): 82-88.
  • Search Plan and Results: CI: Intravenous (IV) Glutamine 2010
     
  In adult patients who are critically ill, does intravenous (IV) glutamine impact infectious complications?

  • Conclusion

    Glutamine (GLN)-supplemented parenteral nutrition (PN) reduced infectious complications in adult critically ill patients in four of five positive quality randomized controlled trials (RCTs).
     

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In adult patients who are critically ill, does intravenous (IV) glutamine impact infectious complications?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Déchelotte P, Hasselmann M, Cynober L, Allaouchiche B, Coëffier M, Hecketsweiler B, Merle V, Mazerolles M, Samba D, Guillou YM, Petit J, Mansoor O, Colas G,Cohendy R, Barnoud D, Czernichow P, Bleichner G. L-alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: The French controlled, randomized, double-blind, multicenter study. Crit Care Med. 2006 Mar; 34(3): 598-604.
      • Estívariz CF, Griffith DP, Luo M, Szeszycki EE, Bazargan N, Dave N, Daignault NM,Bergman GF, McNally T, Battey CH, Furr CE, Hao L, Ramsay JG, Accardi CR, CotsonisGA, Jones DP, Galloway JR, Ziegler TR. Efficacy of parenteral nutrition supplemented with glutamine dipeptide to decrease hospital infections in critically ill surgical patients. JPEN J Parenter Enteral Nutr. 2008 Jul-Aug; 32 (4): 389-402.
      • Fuentes-Orozco C, Anaya-Prado R, González-Ojeda A, Arenas-Márquez H,Cabrera-Pivaral C, Cervantes-Guevara G, Barrera-Zepeda LM. L-alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis. Clin Nutr. 2004 Feb; 23(1): 13-21.
      • Fuentes-Orozco C, Cervantes-Guevara G, Muciño-Hernández I, López-Ortega A,Ambriz-González G, Gutiérrez-de-la-Rosa JL, Gómez-Herrera E, Hermosillo-Sandoval JM, González-Ojeda A. L-alanyl-L-glutamine-supplemented parenteral nutrition decreases infectious morbidity rate in patients with severe acute pancreatitis. J Parenter Enteral Nutr. 2008 Jul-Aug; 32 (4): 403-411.
      • Griffiths RD, Allen KD, Andrews FJ, Jones C. Infection, multiple organ failure, and survival in the intensive care unit: Influence of glutamine-supplemented parenteral nutrition on acquired infection. Nutrition. 2002 Jul-Aug; 18(7-8): 546-552.
      • Yang DL, Xu JF. Effect of dipeptide of glutamine and alanine on severe traumatic brain injury. Chin J Traumatol. 2007; 10(3): 145-149.
  • Search Plan and Results: CI: Intravenous (IV) Glutamine 2010
     
  In adult patients who are critically ill, does intravenous (IV) glutamine impact intensive care unitl (ICU) and hospital length of stay (LOS)?

  • Conclusion

    Glutamine (Gln)-supplemented parenteral nutrition (PN) does not reduce either intensive care unit (ICU) or hospital length of stay (LOS) in adult critically ill patients. Nine of 10 randomized controlled trials (RCTs) reported no difference in either hospital or ICU LOS with Gln added to PN.

     

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In adult patients who are critically ill, does intravenous (IV) glutamine impact intensive care unit (ICU) and hospital length of stay (LOS)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Cai G, Yan J, Zhang Z, Yu Y. Immunomodulatory effects of glutamine enriched nutritional support in elderly patients with severe sepsis: A prospective, randomized, controlled study. J Organ Dysfunction. 2008, 4: 31-37.
      • Déchelotte P, Hasselmann M, Cynober L, Allaouchiche B, Coëffier M, Hecketsweiler B, Merle V, Mazerolles M, Samba D, Guillou YM, Petit J, Mansoor O, Colas G,Cohendy R, Barnoud D, Czernichow P, Bleichner G. L-alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: The French controlled, randomized, double-blind, multicenter study. Crit Care Med. 2006 Mar; 34(3): 598-604.
      • Estívariz CF, Griffith DP, Luo M, Szeszycki EE, Bazargan N, Dave N, Daignault NM,Bergman GF, McNally T, Battey CH, Furr CE, Hao L, Ramsay JG, Accardi CR, CotsonisGA, Jones DP, Galloway JR, Ziegler TR. Efficacy of parenteral nutrition supplemented with glutamine dipeptide to decrease hospital infections in critically ill surgical patients. JPEN J Parenter Enteral Nutr. 2008 Jul-Aug; 32 (4): 389-402.
      • Fuentes-Orozco C, Anaya-Prado R, González-Ojeda A, Arenas-Márquez H,Cabrera-Pivaral C, Cervantes-Guevara G, Barrera-Zepeda LM. L-alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis. Clin Nutr. 2004 Feb; 23(1): 13-21.
      • Fuentes-Orozco C, Cervantes-Guevara G, Muciño-Hernández I, López-Ortega A,Ambriz-González G, Gutiérrez-de-la-Rosa JL, Gómez-Herrera E, Hermosillo-Sandoval JM, González-Ojeda A. L-alanyl-L-glutamine-supplemented parenteral nutrition decreases infectious morbidity rate in patients with severe acute pancreatitis. J Parenter Enteral Nutr. 2008 Jul-Aug; 32 (4): 403-411.
      • Goeters C, Wenn A, Mertes N, Wempe C, Van Aken H, Stehle P, Bone HG. Parenteral L-alanyl-L-glutamine improves SIX-month outcome in critically ill patients. Crit Care Med. 2002 Sep; 30 (9): 2,032-2,037.
      • Powell-Tuck J, Jamieson CP, Bettany GE, Obeid O, Fawcett HV, Archer C, Murphy DL. A double-blind, randomized, controlled trial of glutamine supplementation in parenteral nutrition. Gut. 1999 Jul; 45 (1): 82-88.
      • Yang DL, Xu JF. Effect of dipeptide of glutamine and alanine on severe traumatic brain injury. Chin J Traumatol. 2007; 10(3): 145-149.
      • Ziegler TR, Ogden LG, Singleton KD, Luo M, Fernandez-Estivariz C, Griffith DP,Galloway JR, Wischmeyer PE. Parenteral glutamine increases serum heat shock protein 70 in critically ill patients. Intensive Care Med. 2005 Aug; 31 (8): 1,079-1,086. Epub 2005 Jun 23.
  • Search Plan and Results: CI: Intravenous (IV) Glutamine 2010
     
  In adult patients who are critically ill, does intravenous (IV) glutamine impact ventilator days?

  • Conclusion

    Intravenous (IV) glutamine (Gln) is unlikely to reduce days on mechanical ventilation in adult critically ill patients. Four of five randomized controlled trials (RCTs) reported no difference in mechanical ventilation days with Gln added to PN.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In adult patients who are critically ill, does intravenous (IV) glutamine impact ventilator days?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Cai G, Yan J, Zhang Z, Yu Y. Immunomodulatory effects of glutamine enriched nutritional support in elderly patients with severe sepsis: A prospective, randomized, controlled study. J Organ Dysfunction. 2008, 4: 31-37.
      • Estívariz CF, Griffith DP, Luo M, Szeszycki EE, Bazargan N, Dave N, Daignault NM,Bergman GF, McNally T, Battey CH, Furr CE, Hao L, Ramsay JG, Accardi CR, CotsonisGA, Jones DP, Galloway JR, Ziegler TR. Efficacy of parenteral nutrition supplemented with glutamine dipeptide to decrease hospital infections in critically ill surgical patients. JPEN J Parenter Enteral Nutr. 2008 Jul-Aug; 32 (4): 389-402.
      • Fuentes-Orozco C, Anaya-Prado R, González-Ojeda A, Arenas-Márquez H,Cabrera-Pivaral C, Cervantes-Guevara G, Barrera-Zepeda LM. L-alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis. Clin Nutr. 2004 Feb; 23(1): 13-21.
      • Fuentes-Orozco C, Cervantes-Guevara G, Muciño-Hernández I, López-Ortega A,Ambriz-González G, Gutiérrez-de-la-Rosa JL, Gómez-Herrera E, Hermosillo-Sandoval JM, González-Ojeda A. L-alanyl-L-glutamine-supplemented parenteral nutrition decreases infectious morbidity rate in patients with severe acute pancreatitis. J Parenter Enteral Nutr. 2008 Jul-Aug; 32 (4): 403-411.
      • Ziegler TR, Ogden LG, Singleton KD, Luo M, Fernandez-Estivariz C, Griffith DP,Galloway JR, Wischmeyer PE. Parenteral glutamine increases serum heat shock protein 70 in critically ill patients. Intensive Care Med. 2005 Aug; 31 (8): 1,079-1,086. Epub 2005 Jun 23.
  • Search Plan and Results: CI: Intravenous (IV) Glutamine 2010
     
  In adult patients who are critically ill, does intravenous (IV) glutamine impact cost of care?

  • Conclusion

    It is unclear whether intravenous (IV) glutamine (GLN) impacts cost of care in the intensive care unit (ICU). One older study from the United Kingdom concluded that GLN-supplemented parenteral nutrition (PN) reduced costs in six-month survivors. However, methodologic concerns may limit generalizability.

     

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In adult patients who are critically ill, does intravenous (IV) glutamine impact cost of care?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Griffiths RD, Jones C, Palmer TE. Six-month outcome of critically ill patients given glutamine-supplemented parenteral nutrition. Nutrition. 1997 Apr; 13 (4): 295-302.
  • Search Plan and Results: CI: Intravenous (IV) Glutamine 2010