ABSTRACT
BACKGROUND: Low plasma glutamine concentration is an independent prognostic factor for an unfavourable outcome in the intensive care unit (ICU). Intravenous (i.v.) supplementation with glutamine is reported to improve outcome. In a multi-centric, double-blinded, controlled, randomised, pragmatic clinical trial of i.v. glutamine supplementation for ICU patients, we investigated outcomes regarding sequential organ failure assessment (SOFA) scores and mortality. The hypothesis was that the change in the SOFA score would be improved by glutamine supplementation. METHODS: Patients (n=413) given nutrition by an enteral and/or a parenteral route with the aim of providing full nutrition were included within 72 h after ICU admission. Glutamine was supplemented as i.v. l-alanyl-l-glutamine, 0.283 g glutamine/kg body weight/24 h for the entire ICU stay. Placebo was saline in identical bottles. All included patients were considered as intention-to-treat patients. Patients given supplementation for >3 days were considered as predetermined per protocol (PP) patients. RESULTS: There was a lower ICU mortality in the treatment arm as compared with the controls in the PP group, but not at 6 months. For change in the SOFA scores, no differences were seen, 1 (0,3) vs. 2 (0.4), P=0.792, for the glutamine group and the controls, respectively. CONCLUSION: In summary, a reduced ICU mortality was observed during i.v. glutamine supplementation in the PP group. The pragmatic design of the study makes the results representative for a broad range of ICU patients.
Subject(s)
Critical Care/methods , Glutamine/therapeutic use , APACHE , Adolescent , Adult , Aged , Aged, 80 and over , Databases, Factual , Denmark , Double-Blind Method , Endpoint Determination , Female , Finland , Glutamine/administration & dosage , Hospital Mortality , Humans , Iceland , Injections, Intravenous , Intensive Care Units , Kaplan-Meier Estimate , Male , Middle Aged , Multiple Organ Failure/diagnosis , Multiple Organ Failure/prevention & control , Norway , Sweden , Treatment Outcome , Young AdultABSTRACT
Two patients, a man aged 45 years and a woman aged 61 years, were diagnosed with syringomyelia. They later developed Charcot's arthropathy of the elbow and shoulder, respectively. The second patient was misdiagnosed with multiple sclerosis during the pre-MRI era. The 3 hallmarks of syringomyelia are impairment of vital or non-vital sensory perception, muscle weakness with atrophy and areflexia of the arms. Syringomyelia often occurs in association with other disorders, such as Chiari's malformation type I or tumours of the spinal column. Diagnosis should include scanning of the entire spinal column and the region surrounding the foramen magnum. Various treatment options exist: watchful waiting is possible or surgery, including decompression of the foramen magnum or placement of a syringosubarachnoidal or syringoperitoneal shunt. In the first patient, the elbow became infected, necessitating surgery. The joint later became non-functional. In the second patient, a conservative approach was followed.
