Critical Illness

CI: Supplemental Enteral Glutamine (2010)

• Intervention
  In adult patients who are critically ill, does supplemental enteral glutamine impact infectious complications?

  • Conclusion

    The balance of the evidence does not support the use of supplemental enteral glutamine to reduce infectious complications in adult critically-ill patients.

  • 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 supplemental enteral glutamine impact infectious complications?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Conejero R, Bonet A, Grau T, Esteban A, Mesejo A, Montejo JC, López J, Acosta JA. Effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity at 28 days in critically-ill patients with systemic inflammatory response syndrome: A randomized, single-blind, prospective, multi-center study. Nutrition. 2002 Sep; 18 (9): 716-721.
      • Hall JC, Dobb G, Hall J, de Sousa R, Brennan L, McCauley R. A prospective randomized trial of enteral glutamine in critical illness. Intensive Care Med. 2003 Oct; 29(10): 1,710-1,716.
      • Houdijk AP, Rijnsburger ER, Jansen J, Wesdorp RI, Weiss JK, McCamish MA, Teerlink T, Meuwissen SG, Haarman HJ, Thijs LG, van Leeuwen PA. Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma. Lancet. 1998 Sep 5; 352(9,130): 772-776.
      • Kumar S, Kumar R, Sharma SB, Jain BK. Effect of oral glutamine administration on oxidative stress, morbidity and mortality in critically ill surgical patients. Indian J Gastroenterol. 2007 Mar-Apr; 26(2): 70-73.
      • Schulman AS, Willcutts KF, Claridge JA, O'Donnell KB, Radigan AE, Evans HL, McElearney ST, Hedrick TL, Lowson SM, Schirmer BD, Young JS, Sawyer RG. Does enteral glutamine supplementation decrease infectious morbidity? Surg Infect. 2006 Feb; 7(1): 29-35.
      • Spindler-Vesel A, Bengmark S, Vovk I, Cerovic O, Kompan L. Synbiotics, prebiotics, glutamine or peptide in early enteral nutrition: A randomized study in trauma patients. J Parenter Enteral Nutr. 2007 Mar-Apr; 31 (2): 119-126.
  • Search Plan and Results: CI: Enteral Glutamine 2010
     
  In adult patients who are critically ill, does supplemental enteral glutamine impact mortality?

  • Conclusion

    Evidence does not support the use of supplemental enteral glutamine to reduce mortality in adult critically ill patients.

  • 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 supplemental enteral glutamine impact mortality?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Conejero R, Bonet A, Grau T, Esteban A, Mesejo A, Montejo JC, López J, Acosta JA. Effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity at 28 days in critically-ill patients with systemic inflammatory response syndrome: A randomized, single-blind, prospective, multi-center study. Nutrition. 2002 Sep; 18 (9): 716-721.
      • Hall JC, Dobb G, Hall J, de Sousa R, Brennan L, McCauley R. A prospective randomized trial of enteral glutamine in critical illness. Intensive Care Med. 2003 Oct; 29(10): 1,710-1,716.
      • Kumar S, Kumar R, Sharma SB, Jain BK. Effect of oral glutamine administration on oxidative stress, morbidity and mortality in critically ill surgical patients. Indian J Gastroenterol. 2007 Mar-Apr; 26(2): 70-73.
      • Schulman AS, Willcutts KF, Claridge JA, O'Donnell KB, Radigan AE, Evans HL, McElearney ST, Hedrick TL, Lowson SM, Schirmer BD, Young JS, Sawyer RG. Does enteral glutamine supplementation decrease infectious morbidity? Surg Infect. 2006 Feb; 7(1): 29-35.
      • Spindler-Vesel A, Bengmark S, Vovk I, Cerovic O, Kompan L. Synbiotics, prebiotics, glutamine or peptide in early enteral nutrition: A randomized study in trauma patients. J Parenter Enteral Nutr. 2007 Mar-Apr; 31 (2): 119-126.
  • Search Plan and Results: CI: Enteral Glutamine 2010
     
  In adult patients who are critically ill, does supplemental enteral glutamine impact ventilator days?

  • Conclusion

    Evidence does not support the use of supplemental enteral glutamine to reduce days on mechanical ventilation in adult critically ill patients.

  • 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 supplemental enteral glutamine impact ventilator days?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Conejero R, Bonet A, Grau T, Esteban A, Mesejo A, Montejo JC, López J, Acosta JA. Effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity at 28 days in critically-ill patients with systemic inflammatory response syndrome: A randomized, single-blind, prospective, multi-center study. Nutrition. 2002 Sep; 18 (9): 716-721.
      • Houdijk AP, Rijnsburger ER, Jansen J, Wesdorp RI, Weiss JK, McCamish MA, Teerlink T, Meuwissen SG, Haarman HJ, Thijs LG, van Leeuwen PA. Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma. Lancet. 1998 Sep 5; 352(9,130): 772-776.
      • Spindler-Vesel A, Bengmark S, Vovk I, Cerovic O, Kompan L. Synbiotics, prebiotics, glutamine or peptide in early enteral nutrition: A randomized study in trauma patients. J Parenter Enteral Nutr. 2007 Mar-Apr; 31 (2): 119-126.
  • Search Plan and Results: CI: Enteral Glutamine 2010
     
  In adult patients who are critically ill, does supplemental enteral glutamine impact ICU length of stay (LOS) and hospital LOS?

  • Conclusion

    Evidence does not support the use of supplemental enteral glutamine to reduce LOS in adult critically ill patients.

  • 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 supplemental enteral glutamine impact ICU LOS and hospital LOS?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Conejero R, Bonet A, Grau T, Esteban A, Mesejo A, Montejo JC, López J, Acosta JA. Effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity at 28 days in critically-ill patients with systemic inflammatory response syndrome: A randomized, single-blind, prospective, multi-center study. Nutrition. 2002 Sep; 18 (9): 716-721.
      • Hall JC, Dobb G, Hall J, de Sousa R, Brennan L, McCauley R. A prospective randomized trial of enteral glutamine in critical illness. Intensive Care Med. 2003 Oct; 29(10): 1,710-1,716.
      • Houdijk AP, Rijnsburger ER, Jansen J, Wesdorp RI, Weiss JK, McCamish MA, Teerlink T, Meuwissen SG, Haarman HJ, Thijs LG, van Leeuwen PA. Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma. Lancet. 1998 Sep 5; 352(9,130): 772-776.
  • Search Plan and Results: CI: Enteral Glutamine 2010
     
  In adult patients who are critically ill, does supplemental enteral glutamine impact cost of care?

  • Conclusion

    There were no studies identified to evaluate supplemental enteral glutamine and cost of care in adult critically ill patients.

  • Grade: V
    • 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.
  • Search Plan and Results: CI: Enteral Glutamine 2010