Glutamine

In general, glutamine supplementation should not be utilized in the critically ill, including the critically ill combat trauma patient. This represents a major change from the previous CPG.3 Rationale in favor of glutamine supplementation includes that critically ill patients often have decreased glutamine levels upon ICU admission, low plasma glutamine is associated with increased mortality and there are data to suggest that glutamine supplementation may reduce infections complications.1,2,13-15 However, recent evidence indicates that glutamine supplementation significantly increases mortality rates in the critically ill, and particularly those with significant organ dysfunction syndromes.14-16 The role of glutamine supplementation in trauma and burn patients is less clear. Available evidence regarding the benefits of glutamine supplementation in trauma patients is conflicting and a recent meta-analysis regarding enteral glutamine supplementation in trauma patients found no mortality benefit, and a trend towards decreased infectious morbidity.16 We recommend against enteral or parenteral glutamine supplementation in critically ill combat trauma patients. The only population in which glutamine supplementation should be considered is the patient with isolated burn injury and no evidence of sepsis or multiple organ dysfunction.1,16,17 Results of a large multi-center randomized trial (RE-ENERGIZE) are pending and will further guide the use of glutamine supplementation in the burn population once they are available.