Glutamine may be an essential amino acid in patients with catabolic disease, as it has been demonstrated that circulating glutamine levels drop during critical illness and following major surgery; this may result in an increase in secondary infection risk, recovery time and mortality rates. However, there is much discrepancy in the literature with regards to randomized controlled studies, and therefore, the present study is an umbrella review of published meta-analyses, conducted to examine the effectiveness of glutamine's role as a therapeutic agent. A search using PubMed, Cochrane Library and CINAHL from January 1st, 1980 to December 31st, 2016 was conducted using the following strategy: ‘Glutamine AND (meta-analysis OR systematic review)’ and publications were retrieved, which provided quantitative statistical analysis of pooled treatment effects on the relative risks of infectious complications, mortality and length of stay in hospital. A total of 22 meta-analyses were entered into the current umbrella review. As displayed in Tables I, II and III, these analyses are split into three groups, based on different parameters. Of the 19 meta-analyses investigating the effects of infectious complications, 15 identified statistically significant reductions in complications, with relative risks ranging between 0.42 and 0.93. In addition, 12 of the 18 meta-analyses analyzing the length of hospital stays presented statistically significant reductions in the length of stay, with reductions ranging between 0.19 to 4.73 days. Only 4 of the 15 meta-analyses studying mortality effects identified statistically significant reductions in mortality with relative risks ranging between 0.64 and 1.28. Statistically significant heterogeneity was observed in 16 of 22 meta-analyses, and publication bias was observed in five of 11 meta-analyses. Glutamine supplementation for critically ill or surgical patients through parenteral or enteral routes appears to reduce the rate of hospital acquired infectious complications and shortening of the length of stay in hospital. Furthermore, glutamine supplementation appeared to reduce the rate of in-patient mortality, but the majority of meta-analyses did not reach statistical significance. However, researchers must appreciate the positive results with caution in light of the fact that there exists statistically significant heterogeneity for the majority of meta-analyses, and statistically significant publication bias in almost half.
Revista»Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
In the 20th century early management of acute pancreatitis often included surgical intervention, despite overwhelming mortality. The emergence of high-quality evidence (randomized controlled trials and meta-analyses) over the past two decades has notably shifted the treatment paradigm towards predominantly non-surgical management early in the course of acute pancreatitis. The present evidence-based review focuses on contemporary aspects of early management (which include analgesia, fluid resuscitation, antibiotics, nutrition, and endoscopic retrograde cholangiopancreatography) with a view to providing clear and succinct guidelines on early management of patients with acute pancreatitis in 2017 and beyond.
No existe claridad sobre el efecto del uso de glutamina en pacientes con pancreatitis aguda. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos 15 revisiones sistemáticas que en conjunto incluyen 31 estudios aleatorizados pertinentes a la pregunta. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la glutamina podría disminuir las complicaciones infecciosas en la pancreatitis aguda, pero no está claro si tiene algún efecto sobre la mortalidad o el tiempo de hospitalización porque la certeza de la evidencia es muy baja.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
Las iniciativas internacionales de mejora de la calidad tales como Fast-Hug traer un enfoque en la mejora de la administración de nutrición enteral precoz a los pacientes críticos, sin embargo, las encuestas demuestran la práctica actual sigue siendo variable. Una forma de reducir la variabilidad en la práctica es que proporcionan una fuerte evidencia para convencer a los médicos a cambiar. El propósito de esta revisión fue identificar la mejor evidencia actual apoya la administración de nutrición enteral precoz en la enfermedad crítica. Se buscó evidencia de alta calidad en forma de revisiones sistemáticas que contienen meta-análisis de ensayos controlados aleatorios. Dos autores de forma independiente los estudios identificados y evaluaron la calidad metodológica. Las fuentes de datos incluidos en Medline, EMBASE y búsquedas manuales en las listas de referencias de orientación. La búsqueda bibliográfica identificó cinco revisiones sistemáticas que se resumen 30 ensayos clínicos. Estas revisiones sistemáticas se centró en pacientes hospitalizados agudos, enfermedad grave, quemaduras, cirugía intestinal electiva y pancreatitis. La nutrición enteral precoz redujo significativamente la mortalidad en pacientes sometidos a cirugía electiva intestinales (riesgo relativo: 0,41, 95% intervalo de confianza 0,18 a 0,93, P = 0,03, I 2 = 0,0%) y reduce significativamente las complicaciones infecciosas en pacientes agudamente enfermos hospitalizados (riesgo relativo: 0,45, IC del 95% intervalo de confianza 0,3 a 0,66, p = 0,00006, la heterogeneidad p = 0,049). Cuatro de los cinco identificados tenían importantes revisiones sistemáticas deficiencias de calidad metodológica. Los resultados de esta revisión destacan la variabilidad en la evidencia sobre los beneficios de la nutrición enteral precoz en poblaciones de pacientes en estado crítico. La entrega inconsistentes a los pacientes críticos puede explicarse por la falta de pruebas convincentes. Mejor evidencia puede ser necesaria para reducir la irregularidad en la provisión de nutrición enteral precoz a los pacientes en estado crítico.
Glutamine may be an essential amino acid in patients with catabolic disease, as it has been demonstrated that circulating glutamine levels drop during critical illness and following major surgery; this may result in an increase in secondary infection risk, recovery time and mortality rates. However, there is much discrepancy in the literature with regards to randomized controlled studies, and therefore, the present study is an umbrella review of published meta-analyses, conducted to examine the effectiveness of glutamine's role as a therapeutic agent. A search using PubMed, Cochrane Library and CINAHL from January 1st, 1980 to December 31st, 2016 was conducted using the following strategy: ‘Glutamine AND (meta-analysis OR systematic review)’ and publications were retrieved, which provided quantitative statistical analysis of pooled treatment effects on the relative risks of infectious complications, mortality and length of stay in hospital. A total of 22 meta-analyses were entered into the current umbrella review. As displayed in Tables I, II and III, these analyses are split into three groups, based on different parameters. Of the 19 meta-analyses investigating the effects of infectious complications, 15 identified statistically significant reductions in complications, with relative risks ranging between 0.42 and 0.93. In addition, 12 of the 18 meta-analyses analyzing the length of hospital stays presented statistically significant reductions in the length of stay, with reductions ranging between 0.19 to 4.73 days. Only 4 of the 15 meta-analyses studying mortality effects identified statistically significant reductions in mortality with relative risks ranging between 0.64 and 1.28. Statistically significant heterogeneity was observed in 16 of 22 meta-analyses, and publication bias was observed in five of 11 meta-analyses. Glutamine supplementation for critically ill or surgical patients through parenteral or enteral routes appears to reduce the rate of hospital acquired infectious complications and shortening of the length of stay in hospital. Furthermore, glutamine supplementation appeared to reduce the rate of in-patient mortality, but the majority of meta-analyses did not reach statistical significance. However, researchers must appreciate the positive results with caution in light of the fact that there exists statistically significant heterogeneity for the majority of meta-analyses, and statistically significant publication bias in almost half.
