Amino acid supplements in critically ill patients

Area of Science:

• Clinical Nutrition
• Critical Care Medicine
• Metabolism

Background:

• Observational studies linked low amino acid intake to poor outcomes in critical illness.
• Guidelines recommended early and sufficient amino acid administration.
• Recent high-quality randomized controlled trials (RCTs) challenge these recommendations.

Purpose of the Study:

• To evaluate the efficacy and safety of early amino acid supplementation in critically ill patients.
• To reassess current guidelines regarding amino acid administration during critical illness.

Main Methods:

• Review of recent high-quality randomized controlled trials (RCTs).
• Analysis of potential mechanisms for lack of benefit or harm from amino acid supplementation.
• Assessment of evidence for individual amino acid supplements, including glutamine.

Main Results:

• Several RCTs found no benefit from early amino acid supplementation.
• Some trials indicated potential harm associated with early supplementation.
• No evidence supports individual amino acid supplements; glutamine may be harmful.

Conclusions:

• Current evidence does not support early amino acid supplementation in critical illness.
• The optimal timing, dose, and composition of amino acid mixtures remain undetermined.
• Further research is needed to clarify the role of amino acids in critical care nutrition.