Efficacy and Safety of Glutamine-supplemented Parenteral Nutrition in Surgical ICU Patients: An American Multicenter Randomized Controlled Trial.
Efficacy and Safety of Glutamine-supplemented Parenteral Nutrition in Surgical ICU Patients: An American Multicenter Randomized Controlled Trial.
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DOI：
10.1097/sla.0000000000001487
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发表时间：
2016-04
影响因子：
9
通讯作者：
Wischmeyer PE
中科院分区：
文献类型：
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作者：
Ziegler TR;May AK;Hebbar G;Easley KA;Griffith DP;Dave N;Collier BR;Cotsonis GA;Hao L;Leong T;Manatunga AK;Rosenberg ES;Jones DP;Martin GS;Jensen GL;Sax HC;Kudsk KA;Galloway JR;Blumberg HM;Evans ME;Wischmeyer PE
确定谷氨酰胺（GLN）补充的肠外营养（PN）是否改善外科ICU（SICU）患者的临床结局。GLN的要求可能会随着危重疾病的增加而增加。补充GLN的PN可能改善SICU患者的临床结局，但患者亚组的数据有限。一项在胃肠道、血管或心脏手术后需要PN和SICU护理的成人中进行的平行组、多中心、双盲、随机、对照临床试验。受试者在入组时无显著的肾或肝衰竭或休克。所有动物均接受等氮、等热量PN [1.5 g/kg/d氨基酸（AA）和1.3 ×估计基础能量消耗的能量]。对照组（n = 75）接受标准的不含谷氨酰胺的PN（STD-PN）; GLN组（n = 75）接受含丙氨酰-GLN二肽（0.5 g/kg/d）的PN，按比例替代对照PN（GLN-PN）中的AA。提前进行肠内营养（EN），并根据指示停用PN。住院死亡率和感染是主要终点。两组之间的基线特征、研究PN天数以及PN和EN每日能量和氨基酸/蛋白质摄入量相似。GLN-PN组有11例住院死亡（14.7%），STD-PN组有13例死亡（17.3%;差异，-2.6%; 95%置信区间-14.6至9.3%; P = 0.66）。GLN-PN组6个月累积全因死亡率为31.4%，STD-PN组为29.7%（P = 0.88）。GLN-PN组和STD-PN组的血流感染发生率分别为9.6和8.4/1000住院日（P = 0.73）。其他临床结局和不良事件相似。补充GLN二肽的PN是安全的，但不会改变SICU患者的临床结局。在分解代谢状态下，谷氨酰胺的需求量可能会增加。这项多中心、双盲、随机、对照临床试验评价了谷氨酰胺（GLN）二肽补充的肠外营养（PN）在150名需要术后外科重症监护室（SICU）住院的成人中的安全性和有效性。补充GLN的PN是安全的，但不会改变临床结局。
To determine whether glutamine (GLN)-supplemented parenteral nutrition (PN) improves clinical outcomes in surgical ICU (SICU) patients. GLN requirements may increase with critical illness. GLN-supplemented PN may improve clinical outcomes in SICU patients, but data in patient subgroups are limited. A parallel-group, multicenter, double blind, randomized, controlled clinical trial in adults after gastrointestinal, vascular, or cardiac surgery who required PN and SICU care. Subjects were without significant renal or hepatic failure or shock at entry. All received isonitrogenous, isocaloric PN [1.5 g/kg/d amino acids (AA) and energy at 1.3 × estimated basal energy expenditure]. Controls (n = 75) received standard GLN-free PN (STD-PN); the GLN group (n = 75) received PN containing alanyl-GLN dipeptide (0.5 g/kg/d), proportionally replacing AA in control PN (GLN-PN). Enteral nutrition (EN) was advanced and PN weaned as indicated. Hospital mortality and infections were primary endpoints. Baseline characteristics, days on study PN and daily energy and amino acid/protein intakes via PN and EN were similar between groups. There were 11 hospital deaths (14.7%) in the GLN-PN group and 13 deaths in the STD-PN group and (17.3%; difference, −2.6%; 95% confidence interval −14.6 to 9.3%; P = 0.66). The 6-month cumulative all-cause mortality was 31.4% in the GLN-PN group and 29.7% in the STD-PN group (P = 0.88). Incident bloodstream infection rate was 9.6 and 8.4 per 1000 hospital days in the GLN-PN and STD-PN groups, respectively (P= 0.73). Other clinical outcomes and adverse events were similar. PN supplemented with GLN dipeptide was safe but did not alter clinical outcomes among SICU patients. Glutamine requirements may increase in catabolic states. This multicenter, double blind, randomized, controlled clinical trial evaluated the safety and efficacy of glutamine (GLN) dipeptide-supplemented parenteral nutrition (PN) in 150 adults requiring postoperative surgical intensive care unit (SICU) admission. PN supplemented with GLN was safe but did not alter clinical outcomes.