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

In the last few years, glutamine has changed its status from a "non-essential" amino acid to "almost essential or indispensable" in the critical patient. This has occurred thanks to a series of studies and meta-analysis highlighting the beneficial effects on nosocomial infection, stay in ICU and hospital stay and mortality. After two multicentre studies (REDOXS and MetaPlus) which reviewed the effects of glutamine on critically ill patients, comments changed to: "we do strongly recommend that glutamine is not used in critically ill patients in shock or multiple organ failure" and: "there is an important questioning about the safety of this approach (combination of high- dose enteral and parenteral glutamine) which should not be ignored" and, therefore: "the committee decides to decrease the degree of recommendation for endovenous glutamine"; it currently states that glutamine "should be considered". According to another multicentre study with severe trauma patients our group (a group which in theory was much benefitted from glutamine actions), and 143 patients, did not experience any observable benefit at the usual parenteral doses. We do agree with previous studies on the prognostic value of low levels of glutamine at admittance, which was confirmed if those levels were not back to normal after its administration, although there are no readily available analytic trials for this. This divergence about the usefulness of glutamine grows up as more and more multicentre studies in critical patients show there should be a change of attitude, and probably the clinical guidelines that welcomed its use should now be amended.