Enteral Glutamine Supplementation for the Patient With Major Torso Trauma

Early Enteral Glutamine Supplement to Enteral Nutrition Support of the Major Torso Trauma Patient: Proposal for a Prospective Randomized Clinical Trial

Glutamine is considered a conditionally essential amino acid during critical illness. After severe trauma, glutamine supplementation into the gastrointestinal tract may help maintain bowel function. We hypothesize that for the major torso trauma patient, high dose glutamine given enterally during resuscitation from shock and continued during enteral nutrition support is absorbed, available systemically and preserves gut integrity.

In this prospective, randomized, controlled trial of patients with major torso trauma, high-dose enteral glutamine and enteral nutrition will be given to research subjects while controls will receive isocaloric, isonitrogenous enteral support. Enteral tolerance, bowel integrity and permeability will be evaluated. The systemic appearance of glutamine will be measured.

Inclusion Criteria:

• Adult trauma patients meeting criteria for shock resuscitation
• Major torso trauma
• Admission to the Shock/Trauma Intensive Care Unit

Exclusion Criteria:

• Age <18 years
• Pregnant
• Expected survival < 24 hours
• Bowel in discontinuity
• Renal failure: baseline serum creatinine>3.0 and/or dialysis
• Admission total bilirubin >10 mg/dl
• History of cirrhosis or cirrhosis apparent on exploratory laparotomy
• Asystole or CPR required