A prospective randomized trial of enteral glutamine in critical illness

Objective. To assess the influence of enteral glutamine on the incidence of severe sepsis and death in critically ill patients. Design. This two-armed clinical trial was triple blind (patients, attending staff, research nurse). Setting. The 10 bed general ICU at Royal Perth Hospital, Western Australia. Patients. This trial evaluated 363 patients requiring mechanical ventilation (median APACHE II score=14); of these, 85 had trauma. Intervention. The intervention solution contained 20 g/l glutamine and the control solution was isojoulic and isonitrogenous. Measurements and results. The groups had similar characteristics at baseline, and they also received equivalent amounts of protein and energy. Patients in the glutamine group received a median of 19 g/glutamine per day and 91% (332 of 363) of the patients were fed via a nasogastric tube (median duration=10 days). The outcomes were similar in the two groups: (a) death within 6 months: glutamine group 15% (27 of 179) vs control group 16% (30 of 184); p=0.75; relative risk, 0.95 (95% confidence interval, 0.71-1.28); and (b) severe sepsis: glutamine group 21% (38 of 179) vs control group 23% (43 of 184); p=0.62; relative risk, 0.94 (95% confidence interval, 0.72-1.22). There was also no discernable difference in the secondary outcomes relating to infections, febrile period, antimicrobial therapy, and consumption of inotropes. Conclusion. This clinical trial did not support the use of enteral glutamine supplements in similar cohorts of critically ill patients.