O trabalho concluiu que a nutrição parenteral total suplementada com dipeptídeo Ala-Gln em pacientes de UTI está associada com uma taxa reduzida de complicações infecciosas e melhor tolerância metabólica.
L-alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: The French controlled, randomized, double-blind, multicenter study *.
Critical Care Medicine. 34(3):598-604, March 2006.
Dechelotte, Pierre MD; Hasselmann, Michel MD; Cynober, Luc PharmD; Allaouchiche, Bernard MD; Coeffier, Moise PhD; Hecketsweiler, Bernadette PharmD; Merle, Veronique MD; Mazerolles, Michel MD; Samba, Desire MD; Guillou, Yves Marie MD; Petit, Jean MD; Mansoor, Odile MD; Colas, Gabriel MD; Cohendy, Robert MD; Barnoud, Didier MD; Czernichow, Pierre MD; Bleichner, Gerard MD
Abstract:
Objective: Glutamine (Gln)-supplemented total parenteral nutrition (TPN) improves clinical outcome after planned surgery, but the benefits of Gln-TPN for critically ill (intensive care unit; ICU) patients are still debated.
Design: Prospective, double-blind, controlled, randomized trial.
Setting: ICUs in 16 hospitals in France.
Patients: One-hundred fourteen ICU patients admitted for multiple trauma (38), complicated surgery (65), or pancreatitis (11).
Interventions: Patients were randomized to receive isocaloric isonitrogenous TPN via a central venous catheter providing 37.5 kcal and 1.5 g amino acids[middle dot]kg-1[middle dot]day-1 supplemented with either L-alanyl-L-glutamine dipeptide (0.5 g[middle dot]kg-1[middle dot]day-1; Ala-Gln group, n = 58) or L-alanine + L-proline (control group, n = 56) over at least 5 days.
Measurements and Main Results: Complicated clinical outcome was defined a priori by the occurrence of infectious complications (according to the criteria of the Centers for Disease Control and Prevention), wound complication, or death. The two groups were compared by chi-square test on an intention-to-treat basis. The two groups did not differ at inclusion for type and severity of injury (mean simplified acute physiology score II, 30 vs. 30.5; mean injury severity score, 44.9 vs. 42.3). Similar volumes of TPN were administered in both groups. Ala-Gln-supplemented TPN was associated with a lower incidence of complicated outcome (41% vs. 61%; p < .05), which was mainly due to a reduced infection rate per patient (mean, 0.45 vs. 0.71; p < .05) and incidence of pneumonia (10 vs. 19; p < .05). Early death rate during treatment and 6-month survival were not different. Hyperglycemia was less frequent (20 vs. 30 patients; p < .05) and there were fewer insulin-requiring patients (14 vs. 22; p < .05) in the Ala-Gln group.
Conclusions: TPN supplemented with Ala-Gln dipeptide in ICU patients is associated with a reduced rate of infectious complications and better metabolic tolerance.
