Glutamine Supplemented Parenteral Nutrition to Prevent Ventilator-Associated Pneumonia in the Intensive Care Unit

Abstract

Objective: Ventilator-associated pneumonia (VAP) is a form of nosocomial pneumonia that increases patient morbidity and mortality, length of hospital stay, and healthcare costs. Glutamine preserves the intestinal mucosal structure, increases immune function, and reduces harmful changes in gut permeability in patients receiving total parenteral nutrition (TPN). We hypothesized that TPN supplemented by glutamine might prevent the development of VAP in patients on mechanical ventilator support in the intensive care unit (ICU). Material and Methods: With the approval of the ethics committee and informed consent from relatives, 60 patients who were followed in the ICU with mechanical ventilator support were included in our study. Patients were divided into three groups. The first group received enteral nutrition (n=20), and the second was prescribed TPN (n=20) while the third group was given glutamine-supplemented TPN (n=20). C-reactive protein (CRP), sedimentation rate, body temperature, development of purulent secretions, increase in the amount of secretions, changes in the characteristics of secretions and an increase in requirement of deep tracheal aspiration were monitored for seven days by daily examination and radiographs. Results: No statistically significant difference was found among groups in terms of development of VAP (p=0.622). Conclusion: Although VAP developed at a lower rate in the glutamine-supplemented TPN group, no statistically significant difference was found among any of the groups. Glutamine-supplemented TPN may have no superiority over unsupplemented enteral and TPN in preventing VAP. Turkish Başlık: Yoğun Bakım Ünitesinde Ventilatör İlişkili Pnömoniyi Önlemede Glutamin Destekli Total Parenteral Beslenme Anahtar Kelimeler: Beslenme Desteği, Glutamin, Ventilatör-ilişkili Pnömoni Amaç: Ventilatör ilişkili pnömoni (VAP), mortalite ve morbiditeyi artıran, hastanede kalış süresini uzatan ve hastane giderlerini artıran bir nazokomial pnömoni formudur. Glutamin intestinal mukozal yapıyı korur, immün fonksiyonları artırır ve total parenteral beslenme (TPN) uygulanan hastalarda zararlı değişiklikleri azaltır. Biz yoğun bakım ünitesinde (YBÜ) mekanik ventilatör desteği alan hastalarda VAP gelişiminin glutamin destekli TPN ile önlenebileceği hipotezini kurduk. Materyal ve Metodlar: Çalışmamızda etik kurul onayı ve bilgilendirilmiş onam alındıktan sonra YBÜ'nde mekanik ventilatör desteği alan 60 hasta takip edildi. Hastalar 3 gruba ayrıldı. İlk grup enteral beslenme (n=20) alırken, ikinci gruba TPN (n=20), üçüncü gruba ise glutamin destekli TPN (n=20) başlandı. C-reaktif protein (CRP), sedimentasyon hızı, vücut ısısı, pürülan sekresyon gelişip gelişmediği, sekresyon miktarında artış olup olmadığı, sekresyonların karakterinde değişiklik ve derin trakeal aspirasyon ihtiyacında artış olup olmadığı günlük muayeneler ve radyografi ile takip edildi. Bulgular: Gruplar arasında VAP gelişim açısından istatistiksel olarak anlamlı fark bulunmadı (p=0.622). Sonuç: Glutamin destekli TPN alan grupta daha az oranda VAP gelişmesine rağmen, gruplar arasındaki fark istatistiksel olarak anlamlı değildi. Glutamin destekli TPN, VAP gelişimini önlemede glutaminsiz TPN ve enteral beslenmeden üstün değildir.

Keywords

• Nutritional support, glutamine, ventilator-associated pneumonia

Glutamine Supplemented Parenteral Nutrition to Prevent Ventilator-Associated Pneumonia in the Intensive Care Unit

Öz

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