Glutamine supplementation in trauma ICU patients
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LETTER TO THE EDITOR
Glutamine supplementation in trauma ICU patients Juan Antonio Llompart‑Pou1,2 · Abelardo García de Lorenzo3 · Jon Pérez‑Bárcena1,2 · Joan Maria Raurich1 Received: 6 September 2019 / Accepted: 11 November 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Dear Editor: We read with interest the letter by Stavrou et al. [1] discussing some of the findings of our previously published clinical study in European Journal Trauma Emergency Surgery [2]. In our study, we found an early depletion of plasma AAs concentration which partially recovered at day 6, and unaffected by the route of nutrition. In addition, ALA-GLN dipeptide supplementation produced a marginal increase in plasma levels of alanine, glutamine and citrulline [2]. Stavrou et al. claim for the lack of calculation of sample size and why in figure 3 the effect of various routes of nutritional support was assessed as a whole population with no further distinction on ALA-GLN supplementation or placebo groups. Here, we must acknowledge that the calculation size was performed in accordance to the main outcome measures of the original randomized controlled trial published in 2014 (including mortality and infectious complications) [3] rather than for this specific secondary analysis. This constitutes a limitation of our study. With respect to the different subgroups studied, this information related to the only AAs with differences at day 6 after ALA-GLN supplementation was shown in figure 4. Due to * Juan Antonio Llompart‑Pou [email protected]
the low number of patients in each group (12 in the group of parenteral nutrition), a combined analysis was used to limit spurious associations since separate analyses of each group would likely have been under powered. Finally, we also believe that glutamine might play a role in certain trauma ICU patients, since in our original randomized controlled trial the subgroup of patients who did not normalize glutamine levels at day 6 had more number of infections and ICU and hospital length of stay [3]. However, in our experience in trauma ICU patients, glutamine supplementation using recommended doses did not result in an increase of the expression and functionality of TLR-2 or TLR-4 in peripheral blood monocytes [4, 5] or in clinical benefits in terms of infectious complications, lenght of stay and mortality [3]. Here we agree with Stavrous et al. that a combined approach of glutamine supplementation as theirs [6] is appealing and can be helpful to determine the exact role (if any) of glutamine supplementation in trauma ICU patients.
Compliance with ethical standards Conflict of interest Llompart-Pou JA, Pérez-Bárcena J, and Raurich JM declare no conflict of interest. García de Lorenzo A declares having received speaking honoraria from Fresenius Kabi.
Abelardo García de Lorenzo [email protected]
References
Jon Pérez‑Bárcena [email protected]
1. Stavrou G, Tsaousi G, Kotzampassi K. Effect of the route of nutrition and l-alanyl-l-glutamine supplementation in amino acid
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