Clinical Effects of Postoperative Parenteral Glutamine Dipeptide Supplementation in Surgical Intensive Care Un Patients: A Systematic Review and Meta-Analysis
Mirko Barone1, Regina Frontera2, Rita Vaia Liouras2, Luca Serano2, Massimo Ippoliti1, Ivan Dell’Atti2, Luigi Vetrugno2, Salvatore Maurizio Maggiore2, Felice Mucilli31Department of General and Thoracic Surgery, “SS. Annunziata” University Hospital, Chieti, Italy, 2Department of Anaesthesiology and Intensive Care Medicine, “SS. Annunziata” University Hospital, Chieti, Italy, 3G. d’Annunzio” University, Faculty of Medicine, Chieti, Italy,
Background: Glutamine plays a vital role as an energy substrate the inflammatory response, prevention of organ injury and renal acid buffering. Parenteral glutamine supplementation could reduce in-hospital and ICU morbidity and mortality. Objective: Aim of this systematic review and meta-analysis is to investigate the effects of parenteral administration of GLN in adult surgical critically ill ICU patients. Study selection: Two-arm studies about adult surgical ICU patients undergoing postoperative glutamine-enriched parenteral nutrition (experimental cohorts) vs control ones. Endpoints: Primary endpoint was in-hospital outcome (mortality, length of stay, length of mechanical ventilation). Secondary endpoint was the evaluation of nosocomial infections. Results: According to PRISMA ® 2020 flow diagram, eight randomized controlled trials were included for a total of 603 patients. No significant differences about in-hospital and ICU mortality were found (p=0.16 and p=0.53, respectively). Parenteral glutamine-supplementation was associated with a reduction of hospitalization (p=0.02), without influencing nor ICU stay (p=0.35) neither postoperative mechanical ventilation (p=0.18). Finally, dipeptide administration did not reduced cumulative incidence of nosocomial infections (p=0.41); however, a protective role for postoperative pneumonia was reported (p=0.05). Conclusions: Excepting for a reduction in hospital stay and incidence of nosocomial pneumonia, glutamine-dipeptide parenteral supplementation does not add any benefit in surgical ICU patients. Keywords: Glutamine, parenteral nutrition, intensive care unit, surgery, prognosis
Cite This Article
Barone M, Frontera R, Liouras R, Serano L, Ippoliti M, Dell’Atti I, et al. Clinical Effects of Postoperative Parenteral Glutamine Dipeptide Supplementation in Surgical Intensive Care Un Patients: A Systematic Review and Meta-Analysis. EJMO. 2023; 7(3): 209-219
Corresponding Author: Mirko Barone