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Published on: May 26, 2023
Amino acid concentrations in critically ill children following cardiac surgery*
Marijke Gielen1, Ilse Vanhorebeek, Pieter J Wouters
11Clinical Department and Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium. 2Department of Anaesthesiology and Intensive Care, Karolinska University Hospital, Huddinge, Sweden. 3Department of Clinical Science Intervention and Technology, CLINTEC, Karolinska Institutet, Huddinge, Sweden.
Insights
Critically ill children
Area of Science:
- Pediatric Critical Care Medicine
- Nutritional Biochemistry
- Metabolic Regulation
Background:
- Limited data exist on amino acid levels in critically ill children.
- Current guidelines for amino acid administration lack robust outcome data.
- Understanding amino acid profiles is crucial for optimizing nutritional support.
Purpose of the Study:
- To investigate the time-course of plasma amino acid concentrations in critically ill children.
- To explore associations between amino acid levels, survival, and intensive insulin therapy.
- To examine age-related differences in amino acid profiles.
Main Methods:
- Subanalysis of 100 pediatric patients from a randomized controlled trial in a university hospital Pediatric Intensive Care Unit (PICU).
- Patients underwent cardiac surgery and received standard nutritional care.
- Plasma amino acid concentrations were measured at PICU admission, day 3, and day 7.
Main Results:
- Most amino acid concentrations were similar to healthy children at admission, with dynamic changes over time.
- Non-survivors exhibited higher amino acid levels compared to survivors.
- Intensive insulin therapy reduced total and some individual amino acid concentrations.
- Neonates showed distinct amino acid profiles compared to older children.
Conclusions:
- Circulating amino acid concentrations in critically ill children vary with survival status, glycemic control, and age.
- These findings highlight the dynamic nature of amino acid metabolism during critical illness.
- Further research is needed to refine amino acid administration guidelines.
Objective:
Guidelines for administering amino acids to critically ill children are largely based on uncontrolled observational studies and expert opinion, without support from rigorous outcome studies. Also, data on circulating amino acid concentrations during critical illness are scarce. We thoroughly studied the time profiles of circulating amino acid concentrations in critically ill children who received standard nutritional care according to international guidelines.
Design:
This is a subanalysis of pediatric critically ill patients included in a large (n = 700) randomized controlled study on intensive insulin therapy.
Setting:
The study was conducted at a university hospital PICU.
Patients:
We studied 100 patients in PICU for at least 3 days following cardiac surgery.
Interventions:
Patients were assigned to intensive insulin therapy targeting normal-for-age fasting blood glucose concentrations or insulin infusion only to prevent excessive hyperglycemia.
Measurements And Main Results:
Plasma amino acid concentrations were measured at admission, day 3, and day 7 in PICU. At admission, the concentrations of most amino acids were comparable to those reported for healthy children. Total amino acid concentrations remained stable during ICU stay, but individual amino acids showed different time profiles with eight of them showing an increase and five a decrease. Nonsurviving children had higher total amino acid concentrations and individual amino acids compared with survivors at admission and/or during ICU stay. Intensive insulin therapy lowered the concentrations of total amino acids and several individual amino acids. Neonates showed somewhat different amino acid profiles with rather increased concentrations from baseline with time in ICU for total amino acids and several individual amino acids as compared with older infants and children.
Conclusions:
Circulating amino acid concentrations in critically ill children after cardiac surgery differ according to survival status, blood glucose control with intensive insulin therapy, and age.
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