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The Efficacy of Glutamine Supplementation in Severe Adult Burn Patients: A Systematic Review With Trial Sequential Meta-Analysis.

The Efficacy of Glutamine Supplementation in Severe Adult Burn Patients: A Systematic Review With Trial Sequential Meta-Analysis.

Authors :
Ortiz-Reyes L
Lee ZY
Chin Han Lew C
Hill A
Jeschke MG
Turgeon AF
Cancio L
Stoppe C
Patel JJ
Day AG
Heyland DK
Source :
Critical care medicine [Crit Care Med] 2023 Aug 01; Vol. 51 (8), pp. 1086-1095. Date of Electronic Publication: 2023 Apr 28.
Publication Year :
2023

Abstract

Objectives: Evidence supporting glutamine supplementation in severe adult burn patients has created a state of uncertainty due to the variability in the treatment effect reported across small and large randomized controlled trials (RCTs). We aimed to systematically review the effect of glutamine supplementation on mortality in severe adult burn patients.<br />Data Sources: MEDLINE, Embase, CINAHL, and Cochrane Central were searched from inception to February 10, 2023.<br />Study Selection: RCTs evaluating the effect of enteral or IV glutamine supplementation alone in severe adult burn patients were included.<br />Data Extraction: Two reviewers independently extracted data on study characteristics, burn injury characteristics, description of the intervention between groups, adverse events, and clinical outcomes.<br />Data Synthesis: Random effects meta-analyses were performed to estimate the pooled risk ratio (RR). Trial sequential analyses (TSA) for mortality and infectious complications were performed. Ten RCTs (1,577 patients) were included. We observed no significant effect of glutamine supplementation on overall mortality (RR, 0.65, 95% CI, 0.33-1.28; p = 0.21), infectious complications (RR, 0.83; 95% CI, 0.63-1.09; p = 0.18), or other secondary outcomes. In subgroup analyses, we observed no significant effects based on administration route or burn severity. We did observe a significant subgroup effect between single and multicenter RCTs in which glutamine significantly reduced mortality and infectious complications in singe-center RCTs but not in multicenter RCTs. However, TSA showed that the pooled results of single-center RCTs were type 1 errors and further trials would be futile.<br />Conclusions: Glutamine supplementation, regardless of administration, does not appear to improve clinical outcomes in severely adult burned patients.<br />Competing Interests: Dr. Hill received funding from Fresenius Kabi; she disclosed that she is currently supported by the Medical Faculty Rheinisch-Westfälische Technische Hochschule Aachen University (“Habilitationsstipendium”). Dr. Jeschke received support for article research from the National Institutes of Health. Dr. Cancio disclosed government work. The remaining authors have disclosed that they do not have any potential conflicts of interest.<br /> (Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Details

Language :
English
ISSN :
1530-0293
Volume :
51
Issue :
8
Database :
MEDLINE
Journal :
Critical care medicine
Publication Type :
Academic Journal
Accession number :
37114912
Full Text :
https://doi.org/10.1097/CCM.0000000000005887