OBJECTIVES: Antioxidant depletion is common in critically ill patients. This study was designed to determine the effects of parenteral nutrition (PN), with or without glutamine (Gln) supplementation, on systemic antioxidant status in adult patients after major surgery who required PN in the surgical intensive care unit (SICU) setting. METHODS:Fifty-nine patients in the SICU who required PN after pancreatic surgery or cardiac, vascular, or colonic (non-pancreatic) surgery were randomized in a double-blinded study to receive standard PN (Gln-free) or Gln-supplemented PN (Gln-PN) in which Gln was provided as alanyl-Gln dipeptide. Conventional PN vitamin and mineral doses were administered to all subjects. Plasma concentrations of the antioxidant glutathione (GSH) and the antioxidant nutrients alpha-tocopherol, vitamin C, and zinc were determined at baseline (initiation of study PN) and again after 7 d of study PN. Data were analyzed for the total study cohort and within the pancreatic surgery and non-pancreatic (cardiac, vascular, and colonic) surgery patient subgroups. RESULTS:Mean plasma antioxidant concentrations were within or slightly below the normal ranges at baseline. However, a larger percentage of patients demonstrated below-normal baseline plasma concentrations of GSH (59%), vitamin C (59%), and zinc (68%), respectively. A smaller percentage of patients exhibited below-normal plasma alpha-tocopherol levels (21%). Study PN significantly improved plasma zinc levels in the entire study group and in each surgical subgroup. Gln-PN significantly improved the change in plasma levels of reduced GSH from baseline to day 7 in the non-pancreatic surgery patients (PN -0.27 microM versus Gln-PN +0.26 microM, P < 0.03). CONCLUSION:Low plasma levels of key antioxidants were common in this group of patients in the SICU despite administration of PN containing conventional micronutrients. Compared with standard PN, Gln-supplemented PN improved plasma GSH levels in patients in the SICU after cardiac, vascular, or colonic operations.
RCT Entities:
OBJECTIVES: Antioxidant depletion is common in critically illpatients. This study was designed to determine the effects of parenteral nutrition (PN), with or without glutamine (Gln) supplementation, on systemic antioxidant status in adult patients after major surgery who required PN in the surgical intensive care unit (SICU) setting. METHODS: Fifty-nine patients in the SICU who required PN after pancreatic surgery or cardiac, vascular, or colonic (non-pancreatic) surgery were randomized in a double-blinded study to receive standard PN (Gln-free) or Gln-supplemented PN (Gln-PN) in which Gln was provided as alanyl-Gln dipeptide. Conventional PN vitamin and mineral doses were administered to all subjects. Plasma concentrations of the antioxidant glutathione (GSH) and the antioxidant nutrients alpha-tocopherol, vitamin C, and zinc were determined at baseline (initiation of study PN) and again after 7 d of study PN. Data were analyzed for the total study cohort and within the pancreatic surgery and non-pancreatic (cardiac, vascular, and colonic) surgery patient subgroups. RESULTS: Mean plasma antioxidant concentrations were within or slightly below the normal ranges at baseline. However, a larger percentage of patients demonstrated below-normal baseline plasma concentrations of GSH (59%), vitamin C (59%), and zinc (68%), respectively. A smaller percentage of patients exhibited below-normal plasma alpha-tocopherol levels (21%). Study PN significantly improved plasma zinc levels in the entire study group and in each surgical subgroup. Gln-PN significantly improved the change in plasma levels of reduced GSH from baseline to day 7 in the non-pancreatic surgery patients (PN -0.27 microM versus Gln-PN +0.26 microM, P < 0.03). CONCLUSION: Low plasma levels of key antioxidants were common in this group of patients in the SICU despite administration of PN containing conventional micronutrients. Compared with standard PN, Gln-supplemented PN improved plasma GSH levels in patients in the SICU after cardiac, vascular, or colonic operations.
Authors: P S Samiec; C Drews-Botsch; E W Flagg; J C Kurtz; P Sternberg; R L Reed; D P Jones Journal: Free Radic Biol Med Date: 1998-03-15 Impact factor: 7.376
Authors: C J Schorah; C Downing; A Piripitsi; L Gallivan; A H Al-Hazaa; M J Sanderson; A Bodenham Journal: Am J Clin Nutr Date: 1996-05 Impact factor: 7.045
Authors: Youngja Park; Seoung Bum Kim; Bing Wang; Roberto A Blanco; Ngoc-Anh Le; Shaoxiong Wu; Carolyn J Accardi; R Wayne Alexander; Thomas R Ziegler; Dean P Jones Journal: Am J Physiol Regul Integr Comp Physiol Date: 2009-05-20 Impact factor: 3.619
Authors: Sven Wehner; Katharina Meder; Tim O Vilz; Birgit Alteheld; Peter Stehle; Thomas Pech; Joerg C Kalff Journal: Langenbecks Arch Surg Date: 2011-10-27 Impact factor: 3.445
Authors: German Kamalov; Robert A Ahokas; Wenyuan Zhao; Tieqiang Zhao; Atta U Shahbaz; Patti L Johnson; Syamal K Bhattacharya; Yao Sun; Ivan C Gerling; Karl T Weber Journal: J Cardiovasc Pharmacol Date: 2010-03 Impact factor: 3.105
Authors: Min Han; Suresh Pendem; Suet Ling Teh; Dinesh K Sukumaran; Feng Wu; John X Wilson Journal: Free Radic Biol Med Date: 2009-10-17 Impact factor: 7.376