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Glutamine in critical care: current evidence from systematic reviews

Published online by Cambridge University Press:  07 March 2007

Alison Avenell
Alison Avenell*
Affiliation:
Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
*
Corresponding author: Dr Alison Avenell, fax +44 1224 554580; email [email protected]
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Abstract

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Glutamine, the most abundant amino acid in the body, is thought to become conditionally essential in critical illness. Some of the important roles for glutamine are as a carrier for inter-organ N, a preferred fuel for enterocytes and cells of the immune system, a substrate for renal NH3 formation and a precursor for glutathione. Mechanisms by which glutamine could improve recovery include attenuating oxidant damage and inflammatory cytokine production, reducing gut bacterial translocation and improving N balance. The present systematic review has found trends to suggest that parenteral and enteral glutamine supplementation reduce mortality, the development of infection and organ failure in critical illness. Trials of parenteral nutrition containing glutamine with patients after elective surgery also suggest reduction of infection, but it is unlikely that glutamine-containing parenteral nutrition would be used for such patients. The evidence base is limited by the quality of the reported trials and the suggestion that there is publication bias, with trials suggesting reduced infection being more likely to be published.

Keywords

GlutamineRandomised controlled trialsSystematic reviewsMeta-analysesCritical illness
Type
BAPEN Symposium 4 on ‘Glutamine and antioxidants in critical care’
Information
Proceedings of the Nutrition Society , Volume 65 , Issue 3 , August 2006 , pp. 236 - 241
Copyright
Copyright © The Nutrition Society 2006

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