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Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma
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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“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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ESPEN guideline on clinical nutrition in the intensive care unit.
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“The efficiency of enteral GLN on infection reduction was also suggested in major trauma [216].”
ESPEN guidelines on parenteral nutrition: intensive care
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ESPEN guideline: Clinical nutrition in surgery
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Metadata
- 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
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 1998-09
- Volume
- 352
- Issue
- 9130
- Pages
- 772-776
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- 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
- 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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