A randomized trial of enteral glutamine for the treatment of burn injuries

A randomized trial of enteral glutamine for the treatment of burn injuries

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A recent study found that the use of glutamine supplementation for severely burned patients did not reduce hospital discharge times.

Severe burn injuries are associated with catabolism and intense inflammation which can lead to increased risks of infection, organ problems, and death. Several nutritional strategies have been investigated to treat burns, and there have been conflicting data regarding the efficacy of glutamine use.

There is great interest in glutamine treatment research, as several observational studies have shown that glutamine levels decline rapidly after a severe burn, explained researchers led by Daren K. Heyland, MD, and Lucy Wibbenmeyer, MD.

“A survey of 37 burn units worldwide showed that 47.7% of mechanically ventilated burn patients received glutamine supplementation,” Heyland and colleagues wrote. “However, randomized controlled trials involving other critically ill patient populations have suggested that glutamine administration may be ineffective or even harmful.”

Due to conflicting evidence on glutamine supplementation and to inform clinical recommendations regarding use, the researchers decided to investigate further.

Research and Methods

The researchers conducted the Randomized Trial of Enteral Glutamine to Minimize the Effects of Burn Injury (RE-ENERGIZE), a placebo-randomized, double-blind, parallel-group study, to determine whether or not glutamine therapy would reduce mortality or be removed as such. a practice of health workers and physicians.

In total, 1200 burn patients from 14 countries were included in the randomized trial, from May 2011 to June 2021. The RE-ENERGIZE team recruited participants from various levels of injury, using the following patient recruitment criteria:

  • 18 to 39 years of age, with burn injuries covering ≥20% of their total body surface area.
  • Age 18 to 39 years, with 15% total body surface area along with concomitant inhalation injury.
  • Age 40 to 59 years, with ≥15% of total body surface area.
  • Age ≥ 60 years, with ≥ 10% of the total body surface area.

After receiving informed consent from 1,200 burn patients included in the analysis, the researchers randomly assigned them 1:1 to enteral glutamine or a placebo, each administered within 72 hours of hospital admission. They gave the agents orally 3 or 4 times a day until 7 days after the final skin graft, or through a feeding tube every 4 hours.

Study Results

The researchers included 596 patients in the glutamine-supplemented group and 604 in the placebo group. They found that the median time to hospital discharge was 38 days for the placebo group and 40 days for the glutamine group. Their results did not differ when data were adjusted for site or covariates.

Subdistribution hazard ratios (HRs) were calculated for patients discharged alive, taking into account the competing risk of death. The subdistribution HR for discharge alive was 0.91 (95% CI, 0.80-1.04; P = .17).

Overall, the mortality rate at 6 months of hospitalization was 16.2% for the placebo group and 17.2% for the glutamine supplementation group, with a HR of death among treated patients of 1. 06 (95% CI, 0.80-1.41).

The researchers mainly found no statistically significant differences between the two arms of the clinical trial, with the main exception being slightly elevated increases in urea levels for patients receiving glutamine supplementation. However, they did not observe significant differences in the occurrence of the need for renal replacement therapy or acute kidney injury between both groups.

“The strengths of this trial include its strong scientific methods and high-fidelity implementation, which enhance the internal validity of the findings,” they wrote. “The large number of diverse patients recruited from a large global network of burn units supports the broad generalizability of the findings.”

This study, “A Randomized Trial of Enteral Glutamine for the Treatment of Burn Injuries,” was published online by The New England Journal of Medicine.

#randomized #trial #enteral #glutamine #treatment #burn #injuries

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