The Effect of Administration of Intravenous Glutamine on the Infectious Morbidities in Severely Burn Patients on Enteral Nutrition in the Intensive Care Unit, a Randomized Controlled Trial

Background: Glutamine is an amino acid that has been shown to be beneficial for the metabolically stressed patient, especially the critically ill patients as it is important in modulation of immune cell function and production of cytokines. In this randomized controlled trial, we tested the effects of glutamine supplementation intravenously in severely burn patients receiving enteral nutrition in ICU on infectious complications, number of ventilator free days, number of days of antibiotic use and its effect on the routine blood tests.Patients and Methods: Eighty two patients with burn more than forty percent of BSA in the ICU were randomized into two groups; Group G (glutamine group) and Group C (control group). Patients received continuous intravenous infusion of alanyl-glutamine (0.5g/kg/day) via central venous access until discharge from the ICU, death, or for maximum of 2 weeks and saline (2.5ml/kg/day) in Group C. SOFA score was calculated on admission and on the last day for each patient in the ICU. Rate of infection also was detected regarding surgical site, urinary tract, ventilator associated pneumonia and blood stream infection. We also monitored the ventilator free days and days of antibiotic use.Results: Both groups had similar range of SOFA score (6-14), the mean was (0.07±1.96) in Group G and (0.12±1.54) in Group C,p=(0.91). Number of days of using antibiotics was 6.1±1.8 in Group G and 6.9±1.3 in Group C,p=0.026. Number of ventilator-free days was 3.8±1.8 in Group G and 3.7±0.7 in Group C,p=0.687. Total leucocytic count was 8785±2937 in Group G and 13225±3273 in Group C, p= 0.001. Platelets count was 136.9±33.7 in Group G and 136.8±34.5 in Group C, p=0.997. Conclusion: In burn patients more than 40% in ICU on enteral nutrition, intravenous glutamine showed no effect neither on the SOFA scoring nor on the number of ventilator free days, but there was a significant decrease in the number of days of using antibiotics and the total leucocytic count and overall infectious morbidity.