A NOVEL APPROACH TO EVALUATE THE HOLISTIC CLINICAL UTILITY OF ENTERAL GLUTAMINE SUPPLEMENTATION ON MORBIDITY AND MORTALITY IN MAJOR BURNS
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Keywords
glutamine, burns, burn mortality, enteral glutamine, antioxidants, burns nutrition, burn morbidity, SOFA score, delta sofa, severe burns
Abstract
Introduction- Glutamine plays a vital defensive role in the body during events of acute severe stress including burns, and affects the immune response, inflammatory pathway and catabolic responses.Thus, the effects of glutamine on body defenses is multifold, anddefiningthe criteria for a comprehensive look at the clinical benefit of glutamine supplementation in such cases can be troublesome.In this study, we compare serial sequential organ failure assessment (SOFA) scores, C-reactive protein (CRP) levels and mid-arm circumference (MAC) of burn patients in an attempt to assess the benefit of enteral glutamine supplementation in a holistic sense.
Materials And Methods- The studyincluded60 patients with more than 30% TBSA burns at admission and ages between 18 and 60 years. The subjectswere randomly allocated to two groups of 30 subjects each. The control group received standard nutritional supplementation, and the test group received an additional 0.3g/kg/day of enteral glutamine supplement. SOFA scores were assessed at admission and on day 4, and deltaSOFA (4-0) were calculated. CRP levels were assessed at day 4, 7 and 10 and MAC was measured at admission and at day 10. Results were tabulated and compared statistically.
Results-The average age among the test and control group were 33.50 +/- 12.01 years and 34.47 +/- 11.99 years respectively, with the average percentage of burns in the former and latter groups as 45.87 +/- 15.03 % TBSA and 45.73 +/- 12.99 % TBSA respectively. The deltaSOFA (4-0) among the two groups were 0.04 +/- 1.07 and 1.17 +/- 2.05, with a statistically significant reduction noted (p-value of 0.0444) in the glutamine group. There was a significant reduction (p 0.0173 = 0.0107) in CRP levels at day 10 among the groups, whereas the differences in values at day 4 and 7 were found to be insignificant. The difference in MAC (10-0) was also found to be significant (p = 0.0173).
Conclusion- Prophylactic enteral glutamine supplementation appears to confer protection against immune dysregulation, multi-organ dysfunction and hypercatabolic response in major burns, thereby reducing the overall morbidity and mortality in adult burn population.
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Dr. Vijaykumar N, M.Ch.
Professor & Head, Department Of Plastic, Reconstructive Surgery And Burns Mysore Medical College And Research Institute Mysore, Karnataka, India
Dr. Chandrashekar M S, M.Ch.
Assistant Professor, Department Of Plastic, Reconstructive Surgery And Burns Mysore Medical College And Research Institute Mysore, Karnataka, India
Dr. Mohan G Kakola
Professor, Department Of Plastic, Reconstructive Surgery And Burns Mysore Medical College And Research Institute Mysore, Karnataka, India
Dr. Saikumar P., M.S., (M.Ch.)
Post Graduate, Department Of Plastic, Reconstructive Surgery And Burns Mysore Medical College And Research Institute Mysore, Karnataka, India