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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. 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

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  1. A randomized trial of glutamine and antioxidants in critically ill patients Greg Gaines PA-S

  2. Outline • Glutamine Depletion • Methods • Results • Conclusion

  3. 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

  4. Trial objective • Evaluate the effect of glutamine and antioxidant supplementation • Hypothesis: Supplementation will reduce 28 day mortality • P<0.044 would indicate statistical significance

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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.

  10. 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.

  11. 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>.

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