Effect of the route of glutamine supplementation (enteral versus parenteral) on intestinal permeability on surgical intensive care unit patients: A pilot study

Aim Glutamine administration influences intestinal permeability (IP). Enteral and parenteral glutamine supplementations have different metabolic pathways. In the present study, we investigated the effect of the route of glutamine supplementation on IP. The infection rate, inflammatory parameters and treatment outcome were the secondary end‐points in this study. Patients and Methods A prospective, single‐blind study was performed in mechanically‐ventilated, early enterally‐fed, mixed‐surgery, intensive care unit (ICU) patients, randomly assigned to the parenteral group (group P) or enteral group (group E). The supplemented groups were treated with glutamine for 5 days. IP was measured using the lactulose/mannitol (L/M) test at the end of the study. Results A total of 81 patients completed the study; 39 from group P and 42 from group E. We found no difference in the L/M index (0.492 ± 0.68 group P, 0.521 ± 0.86 group E; P = 0.88) and the ICU‐acquired infection rate (38 per cent group P, 28 per cent group E; P = 0.34). A positive correlation between the start of enteral feeding and the L/M index was confirmed (correlation coefficient: 0.36, P = 0.003), but not with the dose (correlation coefficient: −0.019, P = 0.9) of glutamine supplementation. The outcome data also showed no statistical significant difference. Conclusions The results of this pilot study showed no difference in the IP, infection rate and 6 months' survival between the parenteral or enteral glutamine‐supplemented patients.