Iolanda Jordan1, Mònica Balaguer2, M Esther Esteban3, Francisco José Cambra4, Aida Felipe5, Lluïsa Hernández6, Laia Alsina7, Marta Molero8, Miquel Villaronga9, Elisabeth Esteban10. 1. Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona, Spain. Electronic address: ijordan@hsjdbcn.org. 2. Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona, Spain. Electronic address: mbalaguer@hsjdbcn.org. 3. Department of Animal Biology-Anthropology, Faculty of Biology, University of Barcelona, Barcelona, Spain; Institut de Recerca de la Biodiversitat (IRBIO), University of Barcelona, Barcelona, Spain. Electronic address: mesteban@ub.edu. 4. Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona, Spain. Electronic address: fjcambra@hsjdbcn.org. 5. Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona, Spain. Electronic address: afelipe@hsjdbcn.org. 6. Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona, Spain. Electronic address: lhernandez@hsjdbcn.org. 7. Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain. Electronic address: lalsina@hsjdbcn.org. 8. Clinical Pharmacological Service, Hospital de Sant Joan de Déu, Barcelona, Spain. Electronic address: mmolero@hsjdbcn.org. 9. Clinical Laboratory Service, Hospital de Sant Joan de Déu, Barcelona, Spain. Electronic address: mvillaronga@hsjdbc.org. 10. Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona, Spain. Electronic address: eesteban@hsjdbc.org.
Abstract
BACKGROUND & AIMS: To determine whether glutamine (Gln) supplementation would have a role modifying both the oxidative stress and the inflammatory response of critically ill children. METHODS: Prospective, randomized, double-blind, interventional clinical trial. Selection criteria were children requiring parenteral nutrition for at least 5 days diagnosed with severe sepsis or post major surgery. Patients were randomly assigned to standard parenteral nutrition (SPN, 49 subjects) or standard parenteral nutrition with glutamine supplementation (SPN + Gln, 49 subjects). RESULTS:Glutamine levels failed to show statistical differences between groups. At day 5, patients in the SPN + Gln group had significantly higher levels of HSP-70 (heat shock protein 70) as compared with the SPN group (68.6 vs 5.4, p = 0.014). In both groups, IL-6 (interleukine 6) levels showed a remarkable descent from baseline and day 2 (SPN: 42.24 vs 9.39, p < 0.001; SPN + Gln: 35.20 vs 13.80, p < 0.001) but only the treatment group showed a statistically significant decrease between day 2 and day 5 (13.80 vs 10.55, p = 0.013). Levels of IL-10 (interleukine 10) did not vary among visits except in the SPN between baseline and day 2 (9.55 vs 5.356, p < 0.001). At the end of the study, no significant differences between groups for PICU and hospital stay were observed. No adverse events were detected in any group. CONCLUSIONS:Glutamine supplementation in critically-ill children contributed to maintain high HSP-70 levels for longer. Glutamine supplementation had no influence on IL-10 and failed to show a significant reduction of IL-6 levels.
RCT Entities:
BACKGROUND & AIMS: To determine whether glutamine (Gln) supplementation would have a role modifying both the oxidative stress and the inflammatory response of critically ill children. METHODS: Prospective, randomized, double-blind, interventional clinical trial. Selection criteria were children requiring parenteral nutrition for at least 5 days diagnosed with severe sepsis or post major surgery. Patients were randomly assigned to standard parenteral nutrition (SPN, 49 subjects) or standard parenteral nutrition with glutamine supplementation (SPN + Gln, 49 subjects). RESULTS:Glutamine levels failed to show statistical differences between groups. At day 5, patients in the SPN + Gln group had significantly higher levels of HSP-70 (heat shock protein 70) as compared with the SPN group (68.6 vs 5.4, p = 0.014). In both groups, IL-6 (interleukine 6) levels showed a remarkable descent from baseline and day 2 (SPN: 42.24 vs 9.39, p < 0.001; SPN + Gln: 35.20 vs 13.80, p < 0.001) but only the treatment group showed a statistically significant decrease between day 2 and day 5 (13.80 vs 10.55, p = 0.013). Levels of IL-10 (interleukine 10) did not vary among visits except in the SPN between baseline and day 2 (9.55 vs 5.356, p < 0.001). At the end of the study, no significant differences between groups for PICU and hospital stay were observed. No adverse events were detected in any group. CONCLUSIONS:Glutamine supplementation in critically-ill children contributed to maintain high HSP-70 levels for longer. Glutamine supplementation had no influence on IL-10 and failed to show a significant reduction of IL-6 levels.
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