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Open Access Highly Accessed Research

Parenteral glutamine supplementation in critical illness: a systematic review

Paul E Wischmeyer1*, Rupinder Dhaliwal2, Michele McCall3, Thomas R Ziegler4 and Daren K Heyland25

Author Affiliations

1 Department of Anesthesiology, University of Colorado School of Medicine, 12700 East 19th Avenue, Aurora, CO 80045, USA

2 Clinical Evaluation Research Unit, Kingston General Hospital, 76 Stuart Street, Kingston, ON K7L 2V7, Canada

3 Medical/Surgical Intensive Care Unit, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada

4 Department of Medicine, Center for Clinical and Molecular Nutrition, Emory University School of Medicine, 1648 Pierce Drive North East, Atlanta, GA 30322, USA

5 Department of Medicine, Queens University, Kingston, Ontario, Canada

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Critical Care 2014, 18:R76  doi:10.1186/cc13836

Published: 18 April 2014

Abstract

Introduction

The potential benefit of parenteral glutamine (GLN) supplementation has been one of the most commonly studied nutritional interventions in the critical care setting. The aim of this systematic review was to incorporate recent trials of traditional parenteral GLN supplementation in critical illness with previously existing data.

Methods

All randomized controlled trials of parenterally administered GLN in critically ill patients conducted from 1997 to 2013 were identified. Studies of enteral GLN only or combined enteral/parenteral GLN were excluded. Methodological quality of studies was scored and data was abstracted by independent reviewers.

Results

A total of 26 studies involving 2,484 patients examining only parenteral GLN supplementation of nutrition support were identified in ICU patients. Parenteral GLN supplementation was associated with a trend towards a reduction of overall mortality (relative risk (RR) 0.88, 95% confidence interval (CI) 0.75, 1.03, P = 0.10) and a significant reduction in hospital mortality (RR 0.68, 95% CI 0.51, 0.90, P = 0.008). In addition, parenteral GLN was associated with a strong trend towards a reduction in infectious complications (RR 0.86, 95% CI 0.73, 1.02, P = 0.09) and ICU length of stay (LOS) (WMD –1.91, (95% CI -4.10, 0.28, P = 0.09) and significant reduction in hospital LOS (WMD -2.56, 95% CI -4.71, -0.42, P = 0.02). In the subset of studies examining patients receiving parenteral nutrition (PN), parenteral GLN supplementation was associated with a trend towards reduced overall mortality (RR 0.84, 95% CI 0.71, 1.01, P = 0.07).

Conclusions

Parenteral GLN supplementation given in conjunction with nutrition support continues to be associated with a significant reduction in hospital mortality and hospital LOS. Parenteral GLN supplementation as a component of nutrition support should continue to be considered to improve outcomes in critically ill patients.