Asunto(s)
Cuidados Críticos/métodos , Enfermedad Crítica , Hemodinámica/fisiología , Monitoreo Fisiológico/métodos , Lesión Renal Aguda/fisiopatología , Lesión Renal Aguda/terapia , Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Enfermedades del Sistema Nervioso Autónomo/terapia , Lesiones Encefálicas/fisiopatología , Lesiones Encefálicas/terapia , Humanos , Terapia Nutricional/métodos , Embolia Pulmonar/fisiopatología , Embolia Pulmonar/terapiaRESUMEN
OBJECTIVE: To assess the influence of enteral glutamine on the incidence of severe sepsis and death in critically ill patients. DESIGN: This two-armed clinical trial was triple blind (patients, attending staff, research nurse). SETTING: The 10 bed general ICU at Royal Perth Hospital, Western Australia. PATIENTS: This trial evaluated 363 patients requiring mechanical ventilation (median APACHE II score=14); of these, 85 had trauma. INTERVENTION: The intervention solution contained 20 g/l glutamine and the control solution was isojoulic and isonitrogenous. MEASUREMENTS AND RESULTS: The groups had similar characteristics at baseline, and they also received equivalent amounts of protein and energy. Patients in the glutamine group received a median of 19 g/glutamine per day and 91% (332 of 363) of the patients were fed via a nasogastric tube (median duration=10 days). The outcomes were similar in the two groups: (a) death within 6 months: glutamine group 15% (27 of 179) vs control group 16% (30 of 184); p=0.75; relative risk, 0.95 (95% confidence interval, 0.71-1.28); and (b) severe sepsis: glutamine group 21% (38 of 179) vs control group 23% (43 of 184); p=0.62; relative risk, 0.94 (95% confidence interval, 0.72-1.22). There was also no discernable difference in the secondary outcomes relating to infections, febrile period, antimicrobial therapy, and consumption of inotropes. CONCLUSION: This clinical trial did not support the use of enteral glutamine supplements in similar cohorts of critically ill patients.