RE-ENERGIZE
Trial question
What is the role of supplemental glutamine in patients with severe burns?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
26.0% female
74.0% male
N = 1200
1200 patients (312 female, 888 male).
Inclusion criteria: patients with deep second or third degree burns within 72 hours after hospital admission.
Key exclusion criteria: lack of consent in < 72 hours; moribund state; contraindication to enteral nutrition.
Interventions
N=596 glutamine (0.5 g/kg/day mixed with water given via nasogastric or feeding tube every 4 hours or 3 or 4 times a day by mouth).
N=604 placebo (maltodextrin mixed with water given via nasogastric or feeding tube every 4 hours or 3 or 4 times a day by mouth).
Primary outcome
Time to discharge alive from hospital
40 days
38 days
40.0 days
30.0 days
20.0 days
10.0 days
0.0 days
Glutamine
Placebo
No significant
difference ↔
No significant difference in time to discharge alive from hospital (40 days vs. 38 days; HR 1.01, 95% CI 0.96 to 1.25).
Secondary outcomes
No significant difference in death at 6 months (17.2% vs. 16.2%; HR 1.06, 95% CI 0.8 to 1.41).
No significant difference in death in the hospital (15.3% vs. 13.9%; RR 1.1, 95% CI 0.83 to 1.44).
No significant difference in acquired bacteremia due to Gram-negative organisms (19% vs. 18%; RR 1.05, 95% CI 0.83 to 1.33).
Safety outcomes
No significant differences in serious adverse events, AKI or use of RRT.
Conclusion
In patients with deep second or third degree burns within 72 hours after hospital admission, glutamine was not superior to placebo with respect to time to discharge alive from hospital.
Reference
Daren K Heyland, Lucy Wibbenmeyer, Jonathan A Pollack et al. A Randomized Trial of Enteral Glutamine for Treatment of Burn Injuries. N Engl J Med. 2022 Sep 15;387(11):1001-1010.
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