Mechanical Ventilation Clinical Trial
Official title:
Glutamine Supplementation Guided by Plasma Glutamine Levels
Earlier studies showed a benefit in survival when glutamine was given intravenously and these
studies lead to recommendations that glutamine should be given to critically ill patients.
The ESPEN guidelines recommend 0,2-0,4 g/kg/d intravenous glutamine added to standard
parenteral nutrition .
Until recently it was not possible to obtain a plasma glutamine level fast enough to consider
the result for clinical decision making. With the availability of a Point of Care (POCT)
measurement of plasma glutamine level a measurement can be performed short after the
collection of blood. This offers the possibility to identify a patient with a low plasma
glutamine level shortly after admission and use repeated measurements for evaluation of the
response to supplementation of glutamine.
- At admission (day 0) a plasma glutamine level is measured. The measurement can be
performed from blood taken for the first arterial blood gas analysis. Patients are
eligible for the study when the plasma glutamine level is lower than 420 µmol/l.
- After informed consent is obtained patients are randomised to receive enteral glutamine
or not ( the control group). Enteral glutamine supplementation is started (day 1) at a
dose of 3 sachets per day given at 6.00, 14.00 and 22.00 hr. A sachet contains 9 grams
of L-glutamine ( Glutaperos®, GLNP Life Sciences).
- Enteral glutamine supplementation will be given for a maximum of 10 days or until the
patient is discharged from the ICU.
- Plasma glutamine levels will be measured four times a day, at 06.00, 12.00, 18.00 and
00.00 hours, concurrently with the standard arterial blood gas analyses so no extra
blood is taken from the patient.
- On day 3 at 12.00 hours the dose of glutamine will be increased to 3 times 2 sachets if
plasma glutamine level is still below 420 µmol/l.
- From day 3 ( 12.00 hrs) until day 10 ( end of study) the dosage of enteral glutamine
will be evaluated daily at 12.00 hours. When the plasma glutamine level is higher than
420 µmol/l the dosage of enteral glutamine will be adjusted according to the schedule
below.
- In patients who randomized to the control group, the plasma glutamine level will be
measured daily at 12.00 hr concurrently with standard arterial blood gas analysis
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