Burn injuries represent a public health problem worldwide, and are a leading cause of disability in low and middle-income countries. More so than with any other injury, the inflammation and catabolism associated with severe burns can exacerbate nutrient deficiencies, thereby predisposing patients to impaired immune function and increased risk of developing infectious complications, organ dysfunction, and death. Consequently, over the last few decades numerous trials have evaluated the impact of different nutrition/nutrient strategies in severe burns patients. Glutamine is of particular interest in this regard, as it appears vital for a number of key stress-response pathways in serious illness. The existing randomized trials of glutamine supplementation in burns patients have suggested a significant reduction in mortality, infection, and duration of hospital admissions. However, in other critically ill patient populations, there is a signal of increased mortality associated with glutamine administration. The purpose of the current proposal is to provide the rationale for a large clinical trial of supplemental enteral glutamine in 2,700 severe burn injury patients.
This trial aims to deduce what the effect of enteral glutamine is on the mortality rate at 6 months in patients with severe, life-threatening burn injuries. Additionally, it hopes to monitor these patients to determine what the effect of enteral glutamine is on time-to-discharge alive from hospital and on developing hospital-acquired, bloodstream infections.
Dr Daren Heyland