Skip to main content
Article thumbnail
Location of Repository

Randomised trial of glutamine and selenium supplemented parenteral nutrition for critically ill patients

By Peter J.D. Andrews, Alison Avenell, David W. Noble, Marion Kay Campbell, Claire G. Battison, Bernard L. Croal, William G. Simpson, John David Norrie, Luke David Vale, Jonathan Alistair Cook, Robyn De Verteuil, Anne Catherine Milne and Trials Management Group

Abstract

Background: Mortality rates in the Intensive Care Unit and subsequent hospital mortality rates in the UK remain high. Infections in Intensive Care are associated with a 2–3 times increased risk of death. It is thought that under conditions of severe metabolic stress glutamine becomes "conditionally essential". Selenium is an essential trace element that has antioxidant and anti-inflammatory properties. Approximately 23% of patients in Intensive Care require parenteral nutrition and glutamine and selenium are either absent or present in low amounts. Both glutamine and selenium have the potential to influence the immune system through independent biochemical pathways. Systematic reviews suggest that supplementing parenteral nutrition in critical illness with glutamine or selenium may reduce infections and mortality. Pilot data has shown that more than 50% of participants developed infections, typically resistant organisms. We are powered to show definitively whether supplementation of PN with either glutamine or selenium is effective at reducing new infections in critically ill patients. Methods/design: 2 × 2 factorial, pragmatic, multicentre, double-blind, randomised controlled trial. The trial has an enrolment target of 500 patients. Inclusion criteria include: expected to be in critical care for at least 48 hours, aged 16 years or over, patients who require parenteral nutrition and are expected to have at least half their daily nutritional requirements given by that route. Allocation is to one of four iso-caloric, iso-nitrogenous groups: glutamine, selenium, both glutamine & selenium or no additional glutamine or selenium. Trial supplementation is given for up to seven days on the Intensive Care Unit and subsequent wards if practicable. The primary outcomes are episodes of infection in the 14 days after starting trial nutrition and mortality. Secondary outcomes include antibiotic usage, length of hospital stay, quality of life and cost-effectiveness. Discussion: To date more than 285 patients have been recruited to the trial from 10 sites in Scotland. Recruitment is due to finish in August 2008 with a further six months follow up. We expect to report the results of the trial in summer 2009. Trial registration: This trial is registered with the International Standard Randomised Controlled Trial Number system. ISRCTN87144826Not peer reviewedPublisher PD

Topics: Critical Illness, Pareneteral Nutrition, Randomised Controlled Trial, RC Internal medicine
Publisher: BioMed Central
Year: 2007
DOI identifier: 10.1186/1745-6215-8-25
OAI identifier: oai:aura.abdn.ac.uk:2164/175
Journal:

Suggested articles

Citations

  1. (1999). A: Handling uncertainty when performing economic evaluation of healthcare interventions. Health Technology Assessment doi
  2. An instrument to describe and value health [http:// www.euroqol.org/]
  3. (1988). Armstrong RF: The cost of intensive care: a comparison on one unit between doi
  4. (2000). Assessment of the performance of five intensive care scoring models within a large Scottish database. Crit Care Med doi
  5. (2000). Cost containment through L-alanylL-glutamine supplemented total parenteral nutrition after major abdominal surgery: a prospective randomized doubleblind controlled study. Clin Nutr doi
  6. (2001). Diagnosis of infection in sepsis. Intensive Care Med doi
  7. (1999). Diagnosis of infection in sepsis. Intensive Care Med 2001, 27:S10-32.Page 13 of 14 (page number not for citation purposes) Publication sPolicyAndGuidance/DH_4007921]. 26. Rubenfield
  8. (1993). DW: Patients receiving glutamine-supplemented intravenous feedings report an improvement in mood. JPEN doi
  9. (2000). E: Influence of enteral diets supplemented with key nutrients on lymphocyte subpopulations in Peyer's patches of endotoxin-boostered mice. Clin Nutr doi
  10. (1996). E: Using economics alongside clinical trials: why we cannot choose the evaluation technique in advance. Health Economics doi
  11. (2000). eds: Statistics with confidence 2nd edition.
  12. (1996). Excess mortality and impact of intensive care unit-acquired infections. Curr Opin Anes
  13. (2001). Farrero E, Canvilles JM: Using the EuroQol-5D to measure changes in quality of life 12 months after discharge from an Intensive Care Unit. Intensive Care Medicine doi
  14. (1996). Fearon KC: Effect of glutamine on immune function in the surgical patient. Nutrition doi
  15. (1989). Fürst P: Effect of parenteral glutamine peptide supplements on muscle glutamine loss and nitrogen balance after major surgery. Lancet doi
  16. (1994). Fürst P: Glutaminedipeptide supplemented parenteral nutrition maintains intestinal function in the critically ill. Gastroenterology doi
  17. (1990). GJ: Hepatic iodothyronine 5'-deiodinase: the role of selenium.
  18. (2006). Glutamine in critical care: current evidence from systematic reviews. Proc Nutr Soc doi
  19. (2002). Glutamine supplementation in serious illness: a systematic review of the evidence. Crit Care Med doi
  20. (2000). Health: NHS reference costs
  21. (1996). Hughes JM: The challenge of emerging infectious diseases: Development and spread of multiply-resistant bacterial pathogens. JAMA doi
  22. (2002). Infection, multiple organ failure, and survival in the intensive care unit: influence of glutamine-supplemented parenteral nutrition on acquired infection. Nutrition doi
  23. (1995). Intensive Care Med doi
  24. (1994). IT: SF36 health survey questionnaire: II.Responsiveness to changes in health status in four common clinical conditions. Quality in Health Care doi
  25. (2005). MM: Antioxidanet nutrients: a systematic review of trace elements and vitamins in the critically ill patient. Intens Care Med doi
  26. (1998). MS: An informal assessment of nutritional status in acute stroke for use in an international multicentre trial of feeding regimens.
  27. (2006). Netten A: Unit Costs of Health and Social Care
  28. (1999). Rutala WA: Nosocomial infections in the ICU: The growing importance of antibiotic-resistant pathogens. Chest doi
  29. (2001). Selenium and the "free" electron. Intens Care Med doi
  30. (2004). Selenium supplementation for critically ill adults. The Cochrane Database of Systematic Reviews doi
  31. (1977). Statistical Power analysis for the Behavioural Sciences doi
  32. (1997). TEA: Six-month outcome of critically ill patients given glutamine-supplemented parenteral nutrition. Nutrition doi
  33. (2000). The importance of selenium to human health. Lancet doi
  34. (1995). The intestinal response to critical illness.
  35. (1989). Vinnars E: Addition of glutamine to total parenteral nutrition after elective abdominal surgery spares free glutamine in muscle, counteracts the fall in muscle protein synthesis, and improves nitrogen balance. Ann Surg doi
  36. (1996). WJ: Strategies to prevent and control the emergence and spread of of antimicobial-resistant microorganisms in hospitals. A challenge for medical leadership. JAMA

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.