Exogenous glutamine: the clinical evidence.

Area of Science:

• Critical care medicine
• Nutritional biochemistry
• Clinical nutrition

Background:

• Undernutrition and low body mass index are linked to poorer outcomes in critically ill patients.
• Malnutrition is a significant concern in critical illness, impacting patient prognosis.
• Skeletal muscle protein loss and reduced glutamine levels characterize critical illness metabolism.

Purpose of the Study:

• To critically appraise the existing clinical evidence on glutamine supplementation in critically ill patients.
• To evaluate the impact of glutamine supplementation on mortality and morbidity in critical illness.
• To explore the proposed mechanisms of action for glutamine in critical illness.

Main Methods:

• Systematic review and critical appraisal of published clinical trials.
• Analysis of data on mortality, morbidity, and patient outcomes related to glutamine supplementation.
• Examination of studies investigating glutamine's physiological effects.

Main Results:

• Clinical trials suggest a mortality and morbidity advantage with glutamine supplementation.
• The benefits of glutamine appear dose-dependent and enhanced with parenteral administration.
• Potential mechanisms include immune modulation, antioxidant effects, and influence on glucose metabolism.

Conclusions:

• Glutamine supplementation shows promise in improving outcomes for critically ill patients.
• Further research is needed as the universal benefit of exogenous glutamine is not yet established.
• Parenteral glutamine may offer greater advantages in critical care settings.