Daren K Heyland1,2,3, Paul Wischmeyer4, Marc G Jeschke5, Lucy Wibbenmeyer6, Alexis F Turgeon7,8, Henry T Stelfox9, Andrew G Day2, Dominique Garrel10. 1. Department of Critical Care Medicine, Kingston General Hospital, Kingston, ON, Canada. 2. Department of Public Health Sciences, Queen's University, Kingston, ON, Canada. 3. Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada. 4. Department of Anesthesiology and Surgery, Duke Clinical Research Institute. Duke University School of Medicine, Durham, NC, USA. 5. Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute Department of Surgery, Division of Plastic Surgery, Department of Immunology University of Toronto, Toronto, ON, Canada. 6. University of Iowa Hospitals and Clinics, Iowa City, IA, USA. 7. CHU de Québec - Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec City, QC, Canada. 8. Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, QC, Canada. 9. Department of Critical Care Medicine and O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada. 10. Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
Abstract
BACKGROUND: Burn injury represents a significant public health problem worldwide. More than in any other injury, the inflammation and catabolism associated with severe burns can exacerbate nutrient deficiencies resulting in impaired immune function and increased risk of developing infection, organ dysfunction and death. Consequently, over the last few decades numerous trials have evaluated the impact of different nutritional strategies in severe burn injury. Glutamine is of particular interest, as it appears vital for a number of key stress-response pathways in serious illness. The purpose of the current manuscript is to provide the rationale and protocol for a large clinical trial of supplemental enteral glutamine in 2700 severe burn-injured patients. METHODS: We propose a multicentre, double-blind, pragmatic, randomized, clinical trial involving 80 tertiary intensive care unit (ICU) burn centres worldwide. We aim to enrol patients with deep second- and/or third-degree burns at moderate or high risk for death. We will exclude patients admitted > 72 h before screening and patients with advanced liver and kidney disease. The study intervention consists of enteral glutamine 0.5 g/kg/day vs. isocaloric maltodextran control delivered enterally. Primary outcome will be six-month mortality. Key secondary outcomes include time to discharge alive from hospital, ICU and hospital mortality, length of stay and health-related quality of life at six months. SIGNIFICANCE: This study will be the first large international multicentre trial examining the effects of glutamine in burn patients. Negative or positive, the results of this trial will inform the clinical practice of burns care worldwide.Clinicaltrials.gov ID #NCT00985205.
BACKGROUND: Burn injury represents a significant public health problem worldwide. More than in any other injury, the inflammation and catabolism associated with severe burns can exacerbate nutrient deficiencies resulting in impaired immune function and increased risk of developing infection, organ dysfunction and death. Consequently, over the last few decades numerous trials have evaluated the impact of different nutritional strategies in severe burn injury. Glutamine is of particular interest, as it appears vital for a number of key stress-response pathways in serious illness. The purpose of the current manuscript is to provide the rationale and protocol for a large clinical trial of supplemental enteral glutamine in 2700 severe burn-injured patients. METHODS: We propose a multicentre, double-blind, pragmatic, randomized, clinical trial involving 80 tertiary intensive care unit (ICU) burn centres worldwide. We aim to enrol patients with deep second- and/or third-degree burns at moderate or high risk for death. We will exclude patients admitted > 72 h before screening and patients with advanced liver and kidney disease. The study intervention consists of enteral glutamine 0.5 g/kg/day vs. isocaloric maltodextran control delivered enterally. Primary outcome will be six-month mortality. Key secondary outcomes include time to discharge alive from hospital, ICU and hospital mortality, length of stay and health-related quality of life at six months. SIGNIFICANCE: This study will be the first large international multicentre trial examining the effects of glutamine in burn patients. Negative or positive, the results of this trial will inform the clinical practice of burns care worldwide.Clinicaltrials.gov ID #NCT00985205.
Authors: Palmer Q Bessey; Bart D Phillips; Christopher W Lentz; Linda S Edelman; Iris Faraklas; Margaret A Finocchiaro; Nathan A Kemalyan; Matthew B Klein; Sidney F Miller; Michael J Mosier; Bruce M Potenza; Cynthia L Reigart; Susan M Browning; Maureen T Kiley; John A Krichbaum Journal: J Burn Care Res Date: 2014 May-Jun Impact factor: 1.845
Authors: Paul E Wischmeyer; Rachael A Mintz-Cole; Christine H Baird; Kirk A Easley; Addison K May; Harry C Sax; Kenneth A Kudsk; Li Hao; Phong H Tran; Dean P Jones; Henry M Blumberg; Thomas R Ziegler Journal: Clin Nutr Date: 2019-03-13 Impact factor: 7.324