Enteral glutamine during active shock resuscitation is safe and enhances tolerance of enteral feeding

Margaret McQuiggan, Rosemary Kozar, R. Matthew Sailors, Chul Ahn, Bruce McKinley, Frederick Moore

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background: Feeding the hemodynamically unstable patient is increasingly practiced, yet few data exist on its safety. Because enteral glutamine is protective to the gut in experimental models of shock and improves clinical outcomes, it may benefit trauma patients undergoing shock resuscitation and improve tolerance if administered early. This pilot study aimed to evaluate gastrointestinal tolerance and safety of enteral feeding with glutamine, beginning during shock resuscitation in severely injured patients. Methods: In a prospective randomized trial, 20 patients were randomly assigned to either an enteral glutamine group (n = 10) or a control group (n = 10). Patients with severe trauma meeting standardized shock resuscitation criteria received enteral glutamine 0.5 g/kg/d during the first 24 hours of resuscitation and 10 days thereafter. Immune-enhancing diet began on postinjury day 1, with a target of 25 kcal/kg/d. Control patients received isonitrogenous whey powder plus immuneenhancing diet. Tolerance (vomiting, nasogastric output, diarrhea, and distention) was assessed throughout the study. Results: Glutamine was well tolerated and no adverse events occurred. Treated patients had significantly fewer instances of high nasogastric output (5 vs 23; p = .010), abdominal distention (3 vs 12; p = .021), and total instances of intolerance (8 vs 42; p = .011). Intensive care unit (ICU) and hospital length of stay were comparable. Control patients required supplemental parenteral nutrition (PN) to meet goals at day 7. Conclusions: Enteral glutamine administered during active shock resuscitation and through the early postinjury period is safe and enhances gastrointestinal tolerance. A large clinical trial is warranted to determine if enteral glutamine administered to the hemodynamically unstable patient can reduce infectious morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)28-35
Number of pages8
JournalJournal of Parenteral and Enteral Nutrition
Volume32
Issue number1
DOIs
StatePublished - Jan 2008

Fingerprint

enteral feeding
Enteral Nutrition
Glutamine
Resuscitation
glutamine
Small Intestine
Shock
Length of Stay
whey powder
Diet
Safety
Parenteral Nutrition
Wounds and Injuries
parenteral feeding
vomiting
diet
Powders
Vomiting
Intensive Care Units
morbidity

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Food Science

Cite this

Enteral glutamine during active shock resuscitation is safe and enhances tolerance of enteral feeding. / McQuiggan, Margaret; Kozar, Rosemary; Sailors, R. Matthew; Ahn, Chul; McKinley, Bruce; Moore, Frederick.

In: Journal of Parenteral and Enteral Nutrition, Vol. 32, No. 1, 01.2008, p. 28-35.

Research output: Contribution to journalArticle

McQuiggan, Margaret ; Kozar, Rosemary ; Sailors, R. Matthew ; Ahn, Chul ; McKinley, Bruce ; Moore, Frederick. / Enteral glutamine during active shock resuscitation is safe and enhances tolerance of enteral feeding. In: Journal of Parenteral and Enteral Nutrition. 2008 ; Vol. 32, No. 1. pp. 28-35.
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abstract = "Background: Feeding the hemodynamically unstable patient is increasingly practiced, yet few data exist on its safety. Because enteral glutamine is protective to the gut in experimental models of shock and improves clinical outcomes, it may benefit trauma patients undergoing shock resuscitation and improve tolerance if administered early. This pilot study aimed to evaluate gastrointestinal tolerance and safety of enteral feeding with glutamine, beginning during shock resuscitation in severely injured patients. Methods: In a prospective randomized trial, 20 patients were randomly assigned to either an enteral glutamine group (n = 10) or a control group (n = 10). Patients with severe trauma meeting standardized shock resuscitation criteria received enteral glutamine 0.5 g/kg/d during the first 24 hours of resuscitation and 10 days thereafter. Immune-enhancing diet began on postinjury day 1, with a target of 25 kcal/kg/d. Control patients received isonitrogenous whey powder plus immuneenhancing diet. Tolerance (vomiting, nasogastric output, diarrhea, and distention) was assessed throughout the study. Results: Glutamine was well tolerated and no adverse events occurred. Treated patients had significantly fewer instances of high nasogastric output (5 vs 23; p = .010), abdominal distention (3 vs 12; p = .021), and total instances of intolerance (8 vs 42; p = .011). Intensive care unit (ICU) and hospital length of stay were comparable. Control patients required supplemental parenteral nutrition (PN) to meet goals at day 7. Conclusions: Enteral glutamine administered during active shock resuscitation and through the early postinjury period is safe and enhances gastrointestinal tolerance. A large clinical trial is warranted to determine if enteral glutamine administered to the hemodynamically unstable patient can reduce infectious morbidity and mortality.",
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