肠外营养和重症监护病房患者的谷氨酰胺补充：我们是否正将婴儿与洗澡水一起倒掉？

JPEN J Parenter Enteral Nutr. 2015 Nov;39(8):893-7.

Glutamine Supplementation in Parenteral Nutrition and Intensive Care Unit Patients: Are We Throwing the Baby Out With the Bathwater?

Wischmeyer P.

University of Colorado School of Medicine, Aurora, Colorado.

Clinical research in many fields of medicine, including the intensive care unit (ICU), has demonstrated numerous therapies to be efficacious when targeted to patients with clear clinical or biologic need for the therapy. However, as the eternal search for the “magic bullet” therapy continues to improve outcome in all patients, we often transfer therapies that have been successful in targeted patient groups to all patients aiming for the mythical “goliath trial.” This phenomenon was recently observed with aspirin therapy to reduce myocardial infarction (MI) and stroke. Aspirin has unquestionably been shown to reduce subsequent vascular and cardiac events when given following a previous MI or stroke. However, when given to all patients, regardless of whether they had had a previous MI or stroke, aspirin was shown to markedly increase the risk of gastrointestinal (GI) bleeding and was determined not to be ideal for all patients. This finding did not change the fact that any years of data still demonstrated that aspirin is still clearly indicated in patients following MI or stroke, but the risk of bleeding outweighed the benefit of daily aspirin when given to patients without a clear preexisting data-driven indication. As a result, did we tell all of our patients to stop taking aspirin? Of course not! We only refined our knowledge and learned to use aspirin more safely in the right patients. Our experience in the ICU has been quite similar. This author would roughly estimate that there have been approximately 79 large trials of sepsis therapies of >1000 patients over the past 20 years. Of these, 72 have been negative (no effect of therapy), and 6 showed harm of studied therapy. The 1 study (The Prowess Trial) that showed benefit then, unfortunately, was shown not to be beneficial in 2 subsequent trials.

KEYWORDS: amino acids; critical care; nutrition; parenteral nutrition; research and diseases

PMID: 26136273

DOI: 10.1177/0148607115593792