Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma

Houdijk, Alexander PJ; Rijnsburger, Emmy R; Jansen, Jaap; Wesdorp, Robert IC; Weiss, Jeffery K; McCamish, Mark A; Teerlink, Tom; Meuwissen, Stephan GM; Haarman, Henk J Th M; Thijs, Lambertus G; van Leeuwen, Paul AM

doi:10.1016/s0140-6736(98)02007-8

Cited by 623Clinical Nutrition and GastroenterologySepsis Diagnosis and TreatmentNosocomial Infections in ICU

Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma

Houdijk, Alexander PJ, Rijnsburger, Emmy R, Jansen, Jaap, Wesdorp, Robert IC, Weiss, Jeffery K, McCamish, Mark A, Teerlink, Tom, Meuwissen, Stephan GM +3 more·1998·The Lancet

DOI 10.1016/s0140-6736(98)02007-8

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Abstract

Background Infections are an important cause of morbidity and mortality in patients with multiple trauma. Studies in both animals and human beings have suggested that glutamine-enriched nutrition decreases the number of infections. Methods Patients with multiple trauma with an expected survival of more than 48 h, and who had an Injury Severity Score of 20 or more, were randomly allocated glutamine supplemented enteral nutrition or a balanced, isonitrogenous, isocaloric enteral-feeding regimen along with usual care. Each patient was assessed every 8 h for infection, the primary endpoint. Data were analysed both per protocol, which included enteral feeding for at least 5 days, and by intention to treat. Findings 72 patients were enrolled and 60 received enteral feeding (29 glutamine-supplemented) for at least 5 days. Five (17%) of 29 patients in the glutamine-supplemented group had pneumonia compared with 14 (45%) of 31 patients in the control group (p<0.02). Bacteraemia occurred in two (7%) patients in glutamine group and 13 (42%) in the control group (p<0.005). One patient in the glutamine group had sepsis compared with eight (26%) patients in the control group (p<0.02). Interpretation There was a low frequency of pneumonia, sepsis, and bacteraemia in patients with multiple trauma who received glutamine-supplemented enteral nutrition. Larger studies are needed to investigate whether glutamine-supplemented enteral nutrition reduces mortality.

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Analysis of burn exudates shows that GLN is lost in larger amounts than any other amino acid.
“This higher requirement is explained by exudative losses: analysis of burn exudates shows that GLN is lost in larger amounts than any other amino acid (218).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [218]

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Self-citation

Authors: Houdijk, A. P., Rijnsburger, E. R., Jansen, J., Wesdorp, R. I., Weiss, J. K., McCamish, M. A., Teerlink, T., Meuwissen, S. G., Haarman, H. J. T. M., Thijs, L. G., & van Leeuwen, P. A.
Affiliations: Amsterdam UMC Location University of Amsterdam (NL)
The Ohio State University (US)
ORCID: Houdijk, Alexander PJ
Jansen, Jaap
Venue: The Lancet
Publisher: Elsevier BV
Published: 1998-09
Volume: 352
Issue: 9130
Pages: 772-776
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(98)02007-8
OpenAlex: W2137842935
Cited by: 620
References: 32
Citations by year: 2026: 2 · 2025: 2 · 2024: 5 · 2023: 7 · 2022: 3 · 2021: 7 · 2020: 7 · 2019: 9 · 2018: 7 · 2017: 10 · 2016: 16 · 2015: 19 · 2014: 24 · 2013: 22 · 2012: 18
FWCI: 38.52
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
Funders: Nederlandse Organisatie voor Wetenschappelijk Onderzoek
Topics: Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
Keywords: glutamine supplementation, enteral nutrition, polytrauma, infection control, pneumonia, bacteremia, sepsis, critically ill patients, nutritional support
MeSH terms: Adult, Aged, Arginine, Cross Infection, Enteral Nutrition, Glutamine, Humans, Length of Stay, Middle Aged, Multiple Trauma, Pneumonia, Injury Severity Score, Bacteremia

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Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma

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