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A randomized trial of glutamine and antioxidants in critically ill patients. Greg Gaines PA-S. Outline. Glutamine Depletion Methods Results Conclusion. Glutamine Depletion. In critically ill patients there is rapid depletion of plasma glutamine levels Associated with increased mortality

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a randomized trial of glutamine and antioxidants in critically ill patients

A randomized trial of glutamine and antioxidants in critically ill patients

Greg Gaines PA-S

outline
Outline
  • Glutamine Depletion
  • Methods
  • Results
  • Conclusion
glutamine depletion
Glutamine Depletion
  • In critically ill patients there is rapid depletion of plasma glutamine levels
    • Associated with increased mortality
  • Hypothesized that critically ill patients with organ dysfunction would be most likely to have low plasma glutamine levels
trial objective
Trial objective
  • Evaluate the effect of glutamine and antioxidant supplementation
  • Hypothesis: Supplementation will reduce 28 day mortality
  • P<0.044 would indicate statistical significance
methods
Methods
  • Blinded 2-by-2 study
  • Patient Population
    • 1218 critically ill adults
      • Multiorgan failure
      • Mechanical ventilation
  • Location of the trial
    • 40 different ICUs
    • United States, Canada, Europe
    • April 2005 - December 2011
methods1
Methods
  • Patients were given
    • Glutamine (303)
    • Antioxidants (308)
    • Both (310)
    • Placebo (302)
  • Administration
    • Within 24 of admission
    • Intravenously and enterally
    • For a maximum of 28, until discharge, or death
results
results
  • 70.9% of enteral study supplements
  • 89.1% of IV study supplements
  • 28-day mortality: 29.8% (95% CI, 27.2-32.5)
    • Glutamine had increased mortality trend (32.4% vs. 27.2%)
    • Antioxidants had no difference
    • Glutamine and Antioxidants together had no significant difference
  • 6 month mortality
    • Significantly increase with patients who received glutamine
    • Discharge median time from the ICU was significantly increased
    • Antioxidant had no results
conclusion
conclusion
  • Glutamine
    • Nonsignificant 28-day mortality increase
    • Significant increase in in-hospital and 6-month mortality
    • No other effect
    • Unknown how it may cause harm
  • Antioxidant
    • No benefit or harm
      • Study population, dose or administration
reasons for glutamine discrepancy
Reasons for Glutamine discrepancy
  • This is a larger, more methodical trial than those done in the past
  • These patients received the highest dose of glutamine
  • Both intravenous and enteral supplementation
  • Targeted critically ill patients, the majority or whom were in shock
  • Supplementation was initiated within 24 hours of admission
  • Most received enteral nutrition
  • Substudy of patients did not consistently find a deficiency of glutamine in 66 patients.
my assessment of the study
My assessment of the study
  • Too many variables
  • Remove the antioxidants from the study
  • Consider finding what percentage of those, if any in the study actually had glutamine deficiency.
  • Consider a study with subjects that have been determined to have glutamine deficiency.
works cited
Works Cited
  • Hayland MD, Daren, , et al. "A Randomized Trial of Glutamine." New England Journal of Medicine. 368.16 (2013): 1489-1497. Print. <http://phdres.caregate.net/jclub-articles/Husain..050713.pdf>.