A randomized, controlled study to evaluate the effect of parenteral glutamine on the reduction of infection related morbidity in burn patients in ICU

Abstract

Background: Burn patients are characterized by alterations within the immune system, increased exposure to infectious complications, sepsis, and potentially organ failure and death. Glutamine supplementation to parenteral nutrition has been proven to be related to improved clinical outcomes in trauma patients. We studied the effect of glutamine supplementation on infection and clinical outcomes among burn patients. Methodology: Sixty burn patients were randomly divided into two equal groups. Group I received 0.5 gm/kg/day glutamine infusion as a part of parenteral nutrition for seven days after ICU admission. Group II received an intravenous placebo by continuous infusion (24 h/day). The primary outcome was the presence of infection assessed by the wound culture over a 15-days period. The secondary outcomes were: blood culture, WBCs count, serum C-reactive protein (CRP) and procalcitonin, sequential organ failure assessment (SOFA) score, and length of stay within the intensive care unit. Results: The results showed that the incidence of positive wound culture was considerably reduced within the glutamine group, e.g., 6 (10%) patients) vs. control 19 (33%) patients; P < 0.001). The incidence of positive blood culture was significantly reduced within the study group (1 case) vs. control (9 cases; P = 0.006). In addition, the WBC, serum CRP and procalcitonin were better; and the SOFA score and the ICU-stay were reduced within the glutamine group vs. the control group. Conclusion: The present results prove that IV glutamine supplementation in adult burn patients can reduce the impact of infectious morbidity and improve the clinical outcome. Ethical committee approval: 19/5/2019 ANETS 4 Trial registration: www.clinicaltrials.gov No. NCT05140772 Abbreviations: ICU - intensive care unit; SOFA - Sequential Organ Failure Assessment; CRP - C-reactive protein; GFR- glomerular filtration rate; TBSA - total body surface area; BMI – Body mass index Key words: Glutamine; Infection; Burn; ICU; Mortality Citation: Eskandr AM, Attalla HA, Massoud ME, Alaa-Eldin A. Aiad AEA. A randomized, controlled study to evaluate the effect of parenteral glutamine on the reduction of infection related morbidity in burn patients in ICU. Anaesth. pain intensive care 2022;26(2):318-325; DOI: 10.35975/apic.v26i3.1898 Received: December 24. 2021, Reviewed: January 18, 2022, Accepted: January 29, 2022