[SIXTH JESUS CULEBRAS' LECTURE: GLUTAMINE AND THE CRITICAL PATIENT: THE END OF AN AGE?]

Area of Science:

• Clinical Nutrition
• Critical Care Medicine
• Amino Acid Metabolism

Background:

• Glutamine was previously considered beneficial for critically ill patients, with studies suggesting positive effects on infection rates, ICU stays, and mortality.
• Emerging evidence from multicenter trials like REDOXS and MetaPlus has challenged these initial findings, prompting a re-evaluation of glutamine's role.

Discussion:

• Concerns have been raised regarding the safety of combined high-dose enteral and parenteral glutamine administration in critically ill patients.
• Recommendations for intravenous glutamine have been downgraded, shifting from strong support to a more cautious 'should be considered' stance.
• A multicenter study on severe trauma patients found no observable benefit from standard parenteral glutamine doses.

Key Insights:

• Low glutamine levels at admission may have prognostic value, especially if they do not normalize after administration, though rapid analytic trials are lacking.
• There is a growing divergence in the scientific community regarding the clinical utility of glutamine supplementation in critical care.

Outlook:

• Clinical guidelines that previously endorsed glutamine use may require amendment based on the latest multicenter study findings.
• Further research is needed to clarify the precise role and safety of glutamine in specific critical care populations.