Document Detail


The effect of L-alanyl-L-glutamine dipeptide supplemented total parenteral nutrition on infectious morbidity and insulin sensitivity in critically ill patients.
MedLine Citation:
PMID:  21336131     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The aim of this study was to assess the clinical efficacy of alanine-glutamine dipeptide-supplemented total parenteral nutrition defined by the occurrence of nosocomial infections. Secondary parameters included Sequential Organ Failure Assessment score, hyperglycemia and insulin needs, intensive care unit and hospital length of stay, and 6-month mortality.
DESIGN: Multicenter, prospective, double-blind, randomized trial.
SETTING: Twelve intensive care units at Spanish hospitals.
PATIENTS: One hundred twenty-seven patients with Acute Physiology and Chronic Health Evaluation II score >12 and requiring parenteral nutrition for 5-9 days.
INTERVENTION: Patients were randomized to receive an isonitrogenous and isocaloric total parenteral nutrition or alanine-glutamine dipeptide-supplemented total parenteral nutrition. Nutritional needs were calculated: 0.25 g N/kg(-1)/d(-1) and 25 kcal/kg(-1)/d(-1). The study group received 0.5 g/kg(-1)/d(-1) of glutamine dipeptide and the control total parenteral nutrition group a similar amount of amino acids. Hyperglycemia was controlled applying an intensive insulin protocol with a target glycemia of 140 mg/dL.
MEASUREMENTS AND MAIN RESULTS: The two groups did not differ at inclusion for the type and severity of injury or the presence of sepsis or septic shock. Caloric intake was similar in both groups. Preprotocol analysis showed that treated patients with alanine-glutamine dipeptide-supplemented total parenteral nutrition had lesser nosocomial pneumonia, 8.04 vs. 29.25 episodes-‰ days of mechanical ventilation (p = .02), and urinary tract infections, 2.5 vs. 16.7 episodes-‰ days of urinary catheter (p = .04). Intensive care unit, hospital, and 6-month survival were not different. Mean plasmatic glycemia was 149 ± 46 mg/dL in the alanine-glutamine dipeptide-supplemented total parenteral nutrition group and 155 ± 51 mg/dL in the control total parenteral nutrition group (p < .04), and mean hourly insulin dose was 4.3 ± 3.3 IU in the alanine-glutamine dipeptide-supplemented total parenteral nutrition group and 4.7 ± 3.7 IU in control total parenteral nutrition group (p < .001). Multivariate analysis showed a 54% reduction of the amount of insulin for the same levels of glycemia in the alanine-glutamine dipeptide-supplemented total parenteral nutrition group.
CONCLUSIONS: Total parenteral nutrition supplemented with alanine-glutamine in intensive care unit patients is associated with a reduced rate of infectious complications and better glycemic control.
Authors:
Teodoro Grau; Alfonso Bonet; Eduardo Miñambres; Laura Piñeiro; José Antonio Irles; Angel Robles; José Acosta; Ignacio Herrero; Venancio Palacios; Jorge Lopez; Antonio Blesa; Pilar Martínez;
Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  Critical care medicine     Volume:  39     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-25     Completed Date:  2011-08-11     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1263-8     Citation Subset:  AIM; IM    
Affiliation:
Hospital Universitario Doce de Octubre, Madrid, Spain. tgrau.hdoc@salud.madrid.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Cohort Studies
Cross Infection / prevention & control*
Dipeptides / therapeutic use*
Double-Blind Method
Female
Humans
Hyperglycemia / prevention & control*
Insulin Resistance*
Intensive Care*
Length of Stay
Male
Middle Aged
Parenteral Nutrition, Total*
Chemical
Reg. No./Substance:
0/Dipeptides; U5JDO2770Z/alanylglutamine
Comments/Corrections
Comment In:
Crit Care Med. 2011 Jun;39(6):1546-7   [PMID:  21610614 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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