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Enteral Glutamine During Active Shock Resuscitation Is Safe and Enhances Tolerance of Enteral Feeding

Margaret McQuiggan, MS, RD, CNSD, Rosemary Kozar, MD, PhD^*, R. Matthew Sailors, BE, Chul Ahn, PhD, Bruce McKinley, PhD and Frederick Moore, MD

From the ^* Department of Surgery, University of Texas Medical School Houston, Houston, Texas; Department of Surgery and Division of Surgical Critical Care and Acute Care Surgery, The Methodist Hospital, Houston, Texas; Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas

Correspondence: Margaret McQuiggan, MS, RD, CNSD, Department of Surgery, The Methodist Hospital, 6550 Fannin 1661A, Houston, TX 77030. Electronic mail may be sent to MMcQuiggan{at}tmhs.org.

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 immune-enhancing 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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