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

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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·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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“In a prospective, randomized study, nutrition was started in 78 patients within 48 h after trauma via a nasoduodenal tube for a minimum of 5 days (68).”
Background
Glutamine
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Nutritional Therapy in Critically Ill and Injured Patients
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Innate Immunity Signaling Pathways: Links between Immunonutrition and Responses to Sepsis
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Background
Methods for Decreasing Risk of Aspiration Pneumonia in Critically Ill Patients
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Stability of N‐Acetylglutamine and Glutamine in Aqueous Solution and in a Liquid Nutritional Product by an Improved HPLC Method
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Combined enteral infusion of glutamine, carbohydrates, and antioxidants modulates gut protein metabolism in humans
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Glutamine Reduces Phorbol‐12,13‐Dibutyrate‐Induced Macromolecular Hyperpermeability in HT‐29Cl.19A Intestinal Cells
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Self-citation
Enteral Nutrition and Tube Feeding
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Glutamine modulates CD8αα+ TCRαβ+ intestinal intraepithelial lymphocyte expression in mice with polymicrobial sepsis
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Glutamine preconditioning protects against tour-niquet-induced local and distant organ injury in a rodent ischemia-reperfusion model
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Bacterial γ-glutamyltranspeptidases, physiological function, structure, catalytic mechanism and application
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“Thus, Houdijk et al (21) showed a lower incidence of pneumonia and reduction in bacteremia and sepsis in polytraumatized patients enterally supplemented with GLN and with variations of glutaminemia similar to what was observed in the present work.”
BackgroundResult
Nutrition in intensive care: give enough but choose the route wisely?
Griffiths, R. D. (2001) · Nutrition (Burbank, Los Angeles County, Calif.) · doi:10.1016/s0899-9007(00)00541-4 · Cited by 21
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“In trauma patients, enteral nutritional supplementation with glutamine, the precursor of glutathione, lowered infectious morbidity possibly by affecting the immuno-inflammatory response [11,12].”
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Developing a Comprehensive Mechanical Support Program
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“…is reduced in a number of clinical conditions, for example, after thoracoabdominal aortic surgery (Nijveldt et al, 2000), after surgery for esophageal and lung cancer (Naini et al, 1988), after trauma (Houdijk et al, 1998), during sepsis (Freund et al, 1978), and in severe burns (Yu et al, 1995).”
BackgroundSelf-citation
Enteral Glutamine Supplementation in Critically Ill Patients with Burn Injuries: A Retrospective Case‐Control Evaluation
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“A previous research considered that a minimum of 5 days of feeding was necessary for the GLN supplementation to show an effect on infectious morbidity [11].”
Background
How to feed patients with renal dysfunction
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“In a study of 60 trauma patients, those receiving enteral glutamine demonstrated decreased infectious complication.(75) The largest study to date of enteral glutamine in 363 mixed ICU patients demonstrated no difference in 60-day mortality, severe sepsis, or infectious complications.”
Background
Glutamine starvation of monocytes inhibits the ubiquitin–proteasome proteolytic pathway
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Effect of glutamine supplementation on cardiometabolic risk factors and inflammatory markers: a systematic review and meta-analysis
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Plasma glutamine decreases immediately after surgery and is related to incisiveness
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Background
Influence of Glutamine on Intestinal Inflammatory Response, Mucosa Structure Alterations and Apoptosis following Traumatic Brain Injury in Rats
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Nutrición en el paciente quirúrgico: inmunonutrición
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The local vascular tolerance to an intravenous infusion of a concentrated glutamine solution in ICU patients.
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Diretriz BRASPEN de Terapia Nutricional no Paciente Grave
Castro, M. G., Ribeiro, P. C., de Matos, L. B. N., de Abreu, H. B., de Assis, T., Barreto, P. A., Ceniccola, G. D., da Cunha, H. F. R., Gonçalves, R. C., Gonçalves, T. J. M., et al. (2023) · Braspen Journal · doi:10.37111/braspenj.diretrizdoentegrave · Cited by 25

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)
Corresponding author: van Leeuwen, Paul AM
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 › Critical Care and Intensive Care Medicine › 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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