ESPEN 2012 - Late breaking abstract submission

Topic: Late Breaking Abstract

Abs n°:ESPEN12-1893

Abs Title: GLUTAMINE DIPEPTIDE-SUPPLEMENTED PARENTERAL NUTRITION IN SURGICAL ICU PATIENTS: RESULTS OF AN AMERICAN RANDOMIZED, DOUBLE-BLIND, MULTICENTER TRIAL

T. Ziegler ^1,*A. May ²G. Hebbar ¹K. Kudsk ³H. Sax ⁴H. Blumberg ¹K. Easley ¹P. Wischmeyer ⁵

¹Emory University, Atlanta, ²Vanderbilt University, Nashville, ³University of Wisconsin, Madison, ⁴University of California-Los Angeles, Los Angeles, ⁵University of Colorado, Denver, United States

Rationale: Glutamine (GLN)-supplemented parenteral nutrition (PN) may improve clinical outcomes in the intensive care unit (ICU); however, studies in patient subgroups are limited. 

Methods: This double-blind, five-center RCT was in adults requiring ICU care after GI, vascular or cardiac surgery and PN by usual criteria. Subjects did not have chronic renal or hepatic failure or shock at entry. All subjects (N=150) received isonitrogenous, isocaloric PN with 1.5 g/kg/d amino acids, energy at 1.3x BEE and soybean-based lipid. Controls (n=75) received GLN-free PN; the GLN group (n=75) received PN containing alanyl-GLN dipeptide (0.5 g/kg/d) proportionally replacing amino acids in control PN. Enteral nutrition was advanced as tolerated and study PN weaned proportionally. Clinical outcomes were documented, with all infections adjudicated by a blinded ID specialist.

Results: Of 1247 subjects screened, 150 met eligibility criteria and were randomized (4.3-4.5 days after surgery). Baseline demographic, laboratory and clinical indexes and APACHE II scores (control 22 vs. GLN 23) were similar between groups. Total days on study PN (12.6±7.8 vs.13.0±7.6 days; mean ± SD; P=NS), mean daily energy and amino acid/protein intakes and mean daily blood glucose levels (6.4 to 7.1 mmol/L) during study were similar between groups Blood GLN at entry was 403 vs. 437 µM (NS) and rose 33-38% at days 3, 7 and 14 (all P<0.001 vs. control) with GLN-PN. There were no differences between groups in 28-day (16 vs 15%), hospital, or 6-month (30 vs. 31%) mortality rates, new total or site-specific hospital infections, ventilator-free days, serial SOFA scores, or ICU or hospital length of stay. 

Conclusion: In this multicenter, double-blind RCT, PN supplemented with GLN dipeptide did not alter clinical outcomes vs. GLN-free PN in this subgroup of surgical ICU patients. 

Disclosure of Interest: T. Ziegler Grant/Research Support from: Fresenius-KabiA. May: None DeclaredG. Hebbar: None DeclaredK. Kudsk: None DeclaredH. Sax: None DeclaredH. Blumberg: None DeclaredK. Easley: None DeclaredP. Wischmeyer Grant/Research Support from: Fresenius-Kabi

Keywords: GLUTAMINEparenteral nutrition