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Decreased mortality and infectious morbidity in adult burn patients given enteral glutamine supplements: A prospective, controlled, randomized clinical trial*

Garrel, Dominique; Patenaude, Julie; Nedelec, Bernadette; Samson, Louise; Dorais, Judy; Champoux, Julie; D’Elia, Michele; Bernier, Jacques

doi: 10.1097/01.CCM.0000084848.63691.1E
CLINICAL INVESTIGATIONS
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Objective Enteral glutamine supplements have been shown to reduce infectious morbidity in trauma patients, but their effect on burn patients is not known. The objective of this study was to measure the impact of enteral glutamine supplementation on infectious morbidity, length of care, and the immune system in burn patients.

Design Double-blinded, randomized clinical trial.

Setting Burn center.

Patients Forty-five adults with severe burns.

Interventions Patients were randomized to receive either glutamine or an isonitrogenous control mixture until complete healing occurred. Length of care, incidence of positive blood culture, and mortality were recorded. Phagocytosis by circulating polymorphonuclear cells was measured every 3 days.

Measurements and Main Results Patient characteristics were similar in both groups. Four patients were excluded from the analysis, because three of them died within 72 hrs and the fourth could not receive enteral nutrition and amino acid supplements for the first 10 days. Of the remaining 41 patients, length of care in the survivors was not different between groups (0.9 vs. 1.0 days/percent total body surface area for glutamine vs. control, respectively), positive blood culture was three times more frequent in control than in glutamine treatment (4.3 vs. 1.2 days/patient, p < .05), and Pseudomonas aeruginosa was detected in six patients on control and zero on glutamine (p < .05). Phagocytosis by polymorphonuclear cells was not different between groups. Mortality rate was significantly lower in glutamine than in control: intention to treat, two vs. 12 (p < .05); per protocol analysis, zero vs. eight (p < .01).

Conclusions Enteral glutamine supplementation in adult burn patients reduces blood infection by a factor of three, prevents bacteremia with P. aeruginosa, and may decrease mortality rate. It has no effect on level of consciousness and does not appear to influence phagocytosis by circulating polymorphonuclear cells.

From the Burn Centre (DG, BN, LS, JD), Centre hospitalier de l’Université de Montréal, Hôtel-Dieu, Montreal; and Institut national de la recherche scientifique-santé (JP, JC, MD, JB), Institut Armand-Frappier, Pointe Claire, Quebec, Canada.

*See also p. 2555.

Supported, in part, by grant MT-14128 from the Medical Research Council of Canada and the Fondation des Pompiers du Québec pour les Grands Brûlés.

Address requests for reprints to: Dominique Garrel, Research Centre, CHUM—Hôtel-Dieu, Pavillon Masson, 3850 St. Urbain St., Montreal, Quebec, Canada H2W 1T7; E-mail: dominique.garrel@umontreal.ca

The results of this prospective randomized clinical trial show that enteral glutamine reduces blood culture positivity, particularly with Pseudomonas aeruginosa, in adults with severe burns and may be a life-saving intervention.

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