Supplémentation parentérale en glutamine en réanimation : preuves cliniques et mécanismes d'action

Glutamine is considered as a conditionally amino acid in critical illness and injury. Several controlled randomized studies and recent meta-analysis have concluded that glutamine supplementation has beneficial effects on clinical outcome of critically ill patients with a reduction of nosocomial infections, length of hospital stay and even survival. These clinical results are supported by experimental data indicating that glutamine has anti-inflammatory and antioxidant effects, modulates immune response, induces the expression of heat shock protein which are involved in cellular protection, and maintains gut barrier function. Moreover, favourable effects of glutamine on glucose metabolism have been recently reported. In conclusion, parenteral supplementation with glutamine has beneficial effects on the clinical outcome of critically ill patients. Further studies are needed to confirm the benefits of enterally supplied glutamine in critically ill patients.