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Mise à jour sur l'utilisation des pharmaconutriments chez le patient agressé - première partie : Les acides aminés (glutamine, arginine)

par Fraipont, Vincent;Preiser, Jean-Charles
Référence Nutrition clinique et métabolisme, 30, 2, page (133-141)
Publication Publié, 2016-06

Article révisé par les pairs

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Résumé :

The objectives of the pharmaconutrients include the modulation of the inflammatory response frequently observed during critical illness. Numerous multicenter randomized controlled trials tested their efficacy during the past five years and challenged the recommendations. This review will discuss the data focusing on the critically ill adults excluding the burn patients. Among the different pharmaconutrients studied, glutamine was tested in the Scandinavian glutamine trial, SIGNET, REDOXs, Metaplus and the study by Grau et al. These studies consistently reported the absence of beneficial effect of glutamine supplementation on the primary outcome variable and even an increased mortality in two trials. The most recent recommendations argued against the use of enteral or parenteral glutamine except in a patient on total parenteral nutrition without shock and multiple organ failure. No recent data are available to modify the recommendation for not using supplement of arginine or alpha-cetoglutarate in the critical care patient.