Efficacy and safety of glutamine-supplemented parenteral nutrition in surgical ICU patients: An American mul ticenter rand omized controlled trial

Thomas R. Ziegler, Addison K. May, Gautam Hebbar, Kirk A. Easley, Daniel P. Griffith, Nisha Dave, Bryan R. Collier, George A. Cotsonis, Li Hao, Traci Leong, Amita K. Manatunga, Eli S. Rosenberg, Dean P. Jones, Gregory S. Martin, Gordon L. Jensen, Harry C. Sax, Kenneth A. Kudsk, John R. Galloway, Henry M. Blumberg, Mary E. EvansPaul E. Wischmeyer

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22 Citations (Scopus)

Abstract

Objective: To determine whether glutamine (GLN)-supplemented parenteral nutrition (PN) improves clinical outcomes in surgical intensive care unit (SICU) patients. Summary Background Data: GLN requirements may increase with critical illness. GLN-supplemented PN may improve clinical outcomes in SICU patients. Methods: A parallel-group, multicenter, double-blind, randomized, controlled clinical trial in 150 adults after gastrointestinal, vascular, or cardiac surgery requiring PN and SICU care. Patients were without significant renal or hepatic failure or shock at entry. All received isonitrogenous, isocaloric PN [1.5 g/kg/d amino acids (AAs) and energy at 1.3× estimated basal energy expenditure]. Controls (n = 75) received standard GLN-free PN (STD-PN); the GLN group (n = 75) received PN containing alanyl-GLN dipeptide (0.5 g/kg/d), proportionally replacing AA in PN (GLN-PN). Enteral nutrition (EN) was advanced and PN weaned as indicated. Hospital mortality and infections were primary endpoints. Results: Baseline characteristics, days on study PN and daily macronutrient intakes via PN and EN, were similar between groups. There were 11 hospital deaths (14.7%) in the GLN-PN group and 13 deaths in the STD-PN group (17.3%; difference,-2.6%; 95% confidence interval,-14.6% to 9.3%; P = 0.66). The 6-month cumulative mortality was 31.4% in the GLN-PN group and 29.7% in the STD-PN group (P = 0.88). Incident bloodstream infection rate was 9.6 and 8.4 per 1000 hospital days in the GLN-PN and STD-PN groups, respectively (P = 0.73). Other clinical outcomes and adverse events were similar. Conclusions: PN supplemented with GLN dipeptide was safe, but did not alter clinical outcomes among SICU patients.

Original languageEnglish (US)
Pages (from-to)646-655
Number of pages10
JournalAnnals of surgery
Volume263
Issue number4
DOIs
StatePublished - Jan 1 2016

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Parenteral Nutrition
Glutamine
Safety
Critical Care
Intensive Care Units
Dipeptides
Enteral Nutrition
alanylglutamine
Amino Acids
Liver Failure
Cross Infection
Hospital Mortality
Critical Illness
Energy Metabolism
Thoracic Surgery
Renal Insufficiency
Blood Vessels
Shock

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Ziegler, Thomas R. ; May, Addison K. ; Hebbar, Gautam ; Easley, Kirk A. ; Griffith, Daniel P. ; Dave, Nisha ; Collier, Bryan R. ; Cotsonis, George A. ; Hao, Li ; Leong, Traci ; Manatunga, Amita K. ; Rosenberg, Eli S. ; Jones, Dean P. ; Martin, Gregory S. ; Jensen, Gordon L. ; Sax, Harry C. ; Kudsk, Kenneth A. ; Galloway, John R. ; Blumberg, Henry M. ; Evans, Mary E. ; Wischmeyer, Paul E. / Efficacy and safety of glutamine-supplemented parenteral nutrition in surgical ICU patients : An American mul ticenter rand omized controlled trial. In: Annals of surgery. 2016 ; Vol. 263, No. 4. pp. 646-655.
@article{deb8ce53dd2548f8b8299203ce655790,
title = "Efficacy and safety of glutamine-supplemented parenteral nutrition in surgical ICU patients: An American mul ticenter rand omized controlled trial",
abstract = "Objective: To determine whether glutamine (GLN)-supplemented parenteral nutrition (PN) improves clinical outcomes in surgical intensive care unit (SICU) patients. Summary Background Data: GLN requirements may increase with critical illness. GLN-supplemented PN may improve clinical outcomes in SICU patients. Methods: A parallel-group, multicenter, double-blind, randomized, controlled clinical trial in 150 adults after gastrointestinal, vascular, or cardiac surgery requiring PN and SICU care. Patients were without significant renal or hepatic failure or shock at entry. All received isonitrogenous, isocaloric PN [1.5 g/kg/d amino acids (AAs) and energy at 1.3× estimated basal energy expenditure]. Controls (n = 75) received standard GLN-free PN (STD-PN); the GLN group (n = 75) received PN containing alanyl-GLN dipeptide (0.5 g/kg/d), proportionally replacing AA in PN (GLN-PN). Enteral nutrition (EN) was advanced and PN weaned as indicated. Hospital mortality and infections were primary endpoints. Results: Baseline characteristics, days on study PN and daily macronutrient intakes via PN and EN, were similar between groups. There were 11 hospital deaths (14.7{\%}) in the GLN-PN group and 13 deaths in the STD-PN group (17.3{\%}; difference,-2.6{\%}; 95{\%} confidence interval,-14.6{\%} to 9.3{\%}; P = 0.66). The 6-month cumulative mortality was 31.4{\%} in the GLN-PN group and 29.7{\%} in the STD-PN group (P = 0.88). Incident bloodstream infection rate was 9.6 and 8.4 per 1000 hospital days in the GLN-PN and STD-PN groups, respectively (P = 0.73). Other clinical outcomes and adverse events were similar. Conclusions: PN supplemented with GLN dipeptide was safe, but did not alter clinical outcomes among SICU patients.",
author = "Ziegler, {Thomas R.} and May, {Addison K.} and Gautam Hebbar and Easley, {Kirk A.} and Griffith, {Daniel P.} and Nisha Dave and Collier, {Bryan R.} and Cotsonis, {George A.} and Li Hao and Traci Leong and Manatunga, {Amita K.} and Rosenberg, {Eli S.} and Jones, {Dean P.} and Martin, {Gregory S.} and Jensen, {Gordon L.} and Sax, {Harry C.} and Kudsk, {Kenneth A.} and Galloway, {John R.} and Blumberg, {Henry M.} and Evans, {Mary E.} and Wischmeyer, {Paul E.}",
year = "2016",
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doi = "10.1097/SLA.0000000000001487",
language = "English (US)",
volume = "263",
pages = "646--655",
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publisher = "Lippincott Williams and Wilkins",
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Ziegler, TR, May, AK, Hebbar, G, Easley, KA, Griffith, DP, Dave, N, Collier, BR, Cotsonis, GA, Hao, L, Leong, T, Manatunga, AK, Rosenberg, ES, Jones, DP, Martin, GS, Jensen, GL, Sax, HC, Kudsk, KA, Galloway, JR, Blumberg, HM, Evans, ME & Wischmeyer, PE 2016, 'Efficacy and safety of glutamine-supplemented parenteral nutrition in surgical ICU patients: An American mul ticenter rand omized controlled trial', Annals of surgery, vol. 263, no. 4, pp. 646-655. https://doi.org/10.1097/SLA.0000000000001487

Efficacy and safety of glutamine-supplemented parenteral nutrition in surgical ICU patients : An American mul ticenter rand omized controlled trial. / Ziegler, Thomas R.; May, Addison K.; Hebbar, Gautam; Easley, Kirk A.; Griffith, Daniel P.; Dave, Nisha; Collier, Bryan R.; Cotsonis, George A.; Hao, Li; Leong, Traci; Manatunga, Amita K.; Rosenberg, Eli S.; Jones, Dean P.; Martin, Gregory S.; Jensen, Gordon L.; Sax, Harry C.; Kudsk, Kenneth A.; Galloway, John R.; Blumberg, Henry M.; Evans, Mary E.; Wischmeyer, Paul E.

In: Annals of surgery, Vol. 263, No. 4, 01.01.2016, p. 646-655.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Efficacy and safety of glutamine-supplemented parenteral nutrition in surgical ICU patients

T2 - An American mul ticenter rand omized controlled trial

AU - Ziegler, Thomas R.

AU - May, Addison K.

AU - Hebbar, Gautam

AU - Easley, Kirk A.

AU - Griffith, Daniel P.

AU - Dave, Nisha

AU - Collier, Bryan R.

AU - Cotsonis, George A.

AU - Hao, Li

AU - Leong, Traci

AU - Manatunga, Amita K.

AU - Rosenberg, Eli S.

AU - Jones, Dean P.

AU - Martin, Gregory S.

AU - Jensen, Gordon L.

AU - Sax, Harry C.

AU - Kudsk, Kenneth A.

AU - Galloway, John R.

AU - Blumberg, Henry M.

AU - Evans, Mary E.

AU - Wischmeyer, Paul E.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Objective: To determine whether glutamine (GLN)-supplemented parenteral nutrition (PN) improves clinical outcomes in surgical intensive care unit (SICU) patients. Summary Background Data: GLN requirements may increase with critical illness. GLN-supplemented PN may improve clinical outcomes in SICU patients. Methods: A parallel-group, multicenter, double-blind, randomized, controlled clinical trial in 150 adults after gastrointestinal, vascular, or cardiac surgery requiring PN and SICU care. Patients were without significant renal or hepatic failure or shock at entry. All received isonitrogenous, isocaloric PN [1.5 g/kg/d amino acids (AAs) and energy at 1.3× estimated basal energy expenditure]. Controls (n = 75) received standard GLN-free PN (STD-PN); the GLN group (n = 75) received PN containing alanyl-GLN dipeptide (0.5 g/kg/d), proportionally replacing AA in PN (GLN-PN). Enteral nutrition (EN) was advanced and PN weaned as indicated. Hospital mortality and infections were primary endpoints. Results: Baseline characteristics, days on study PN and daily macronutrient intakes via PN and EN, were similar between groups. There were 11 hospital deaths (14.7%) in the GLN-PN group and 13 deaths in the STD-PN group (17.3%; difference,-2.6%; 95% confidence interval,-14.6% to 9.3%; P = 0.66). The 6-month cumulative mortality was 31.4% in the GLN-PN group and 29.7% in the STD-PN group (P = 0.88). Incident bloodstream infection rate was 9.6 and 8.4 per 1000 hospital days in the GLN-PN and STD-PN groups, respectively (P = 0.73). Other clinical outcomes and adverse events were similar. Conclusions: PN supplemented with GLN dipeptide was safe, but did not alter clinical outcomes among SICU patients.

AB - Objective: To determine whether glutamine (GLN)-supplemented parenteral nutrition (PN) improves clinical outcomes in surgical intensive care unit (SICU) patients. Summary Background Data: GLN requirements may increase with critical illness. GLN-supplemented PN may improve clinical outcomes in SICU patients. Methods: A parallel-group, multicenter, double-blind, randomized, controlled clinical trial in 150 adults after gastrointestinal, vascular, or cardiac surgery requiring PN and SICU care. Patients were without significant renal or hepatic failure or shock at entry. All received isonitrogenous, isocaloric PN [1.5 g/kg/d amino acids (AAs) and energy at 1.3× estimated basal energy expenditure]. Controls (n = 75) received standard GLN-free PN (STD-PN); the GLN group (n = 75) received PN containing alanyl-GLN dipeptide (0.5 g/kg/d), proportionally replacing AA in PN (GLN-PN). Enteral nutrition (EN) was advanced and PN weaned as indicated. Hospital mortality and infections were primary endpoints. Results: Baseline characteristics, days on study PN and daily macronutrient intakes via PN and EN, were similar between groups. There were 11 hospital deaths (14.7%) in the GLN-PN group and 13 deaths in the STD-PN group (17.3%; difference,-2.6%; 95% confidence interval,-14.6% to 9.3%; P = 0.66). The 6-month cumulative mortality was 31.4% in the GLN-PN group and 29.7% in the STD-PN group (P = 0.88). Incident bloodstream infection rate was 9.6 and 8.4 per 1000 hospital days in the GLN-PN and STD-PN groups, respectively (P = 0.73). Other clinical outcomes and adverse events were similar. Conclusions: PN supplemented with GLN dipeptide was safe, but did not alter clinical outcomes among SICU patients.

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