News from the Journal of Parenteral and Enteral Nutrition -- JPEN -- May 2014

To help healthcare providers stay abreast of the latest and ever-changing developments in clinical nutrition, the Journal of Parenteral and External Nutrition (JPEN) makes research available as soon as possible. The following is a selection from JPEN's OnlineFirst articles, which are published online before they appear in a regular issue of the Journal:

A common practice for patients with multiorgan failure in intensive care units (ICUs) may actually increase the risk of patient death, according to research published today in the online issue of the Journal of Parenteral and External Nutrition (JPEN), the flagship journal of the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.).

Researchers with the Canadian Critical Care Trials Group found that patients who received glutamine supplements either alone or combined with antioxidants had a significantly higher mortality rate than those who did not receive supplements.

Study author Daren K. Heyland, MD, of Kingston General Hospital, Canada, reports that he and fellow researchers discovered that ICU patients with multiorgan failure who received the supplements had a four to eight percent higher mortality rate than those who received a placebo. It was also found that supplements were most harmful in patients with baseline renal dysfunction.

Glutamine supplements have been commonly given to ICU patients with multiorgan failure to replace key nutrients that are often lacking. These nutrients play a central role in the body's immune system reaction to infections, a common problem in ICUs. Patients infected in ICUs are twice as likely to die during treatment as compared with noninfected patients. Supplements are also used to combat muscle mass loss during prolonged ICU stays.

While it is vital to keep ICU patients strong enough to fight off infections, the current method may be too harmful to continue for patients with multiorgan failure based on this new study. Until more safety and efficacy data become available, the study's researchers suggest that glutamine and antioxidants not be administered to critically ill patients with multiorgan failure, particularly those with concomitant acute renal failure.

Funding for the study was provided by the Canadian Institutes of Health Research; ClinicalTrials.gov number: NCT00133978. Fresenius Kabi provided the glutamine supplements and an unrestricted grant-in-aid. Biosyn provided the intravenous selenium to all participating European sites. The study involved more than 1,200 patients across 40 ICUs in North America and Europe.

A publication of the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), the Journal of Parenteral and Enteral Nutrition (JPEN) is the premier scientific journal of nutrition and metabolic support. It publishes original, peer-reviewed studies that define the cutting edge of basic and clinical research in the field. It explores the science of optimizing the care of patients receiving enteral or intravenous therapies. All published JPEN articles are available online at http://pen.sagepub.com.