A 56-year-old man is hospitalized in the intensive care unit due to community-acquired pneumonia with resultant multiorgan failure. His trachea is intubated and mechanical ventilation is initiated. His family wants to "do everything possible" to make him better and save his life. Based on the study results, which of the following is the best statement concerning the use of glutamine and antioxidants in this patient?

Question

A 56-year-old man is hospitalized in the intensive care unit due to community-acquired pneumonia with resultant multiorgan failure.  His trachea is intubated and mechanical ventilation is initiated.  His family wants to "do everything possible" to make him better and save his life. Based on the study results, which of the following is the best statement concerning the use of glutamine and antioxidants in this patient?

Quizplus · Accepted Answer

Explanation: Compared to the no glutamine group, there was a statistically significant increase in mortality with glutamine supplementation at day 28 (32.4% versus 27.2%) and after 6 months (42.3% versus 35.9%) as the p-values were <0.05. Even at day 14, the increased mortality seen in the glutamine supplementation group had a p-value of 0.07, which is approaching significance. All this suggests that glutamine supplementation may be harmful.(Choice A) Although the risk of mortality was slightly higher in the antioxidant group, none of the differences were statistically significant (p-values were all >0.05), making it inappropriate to draw conclusions about the risk for harm. (Choice B) The reductions in length of stay in the supplemented groups (16.0 versus 17.1 days and 16.9 versus 16.6 days) were not statistically significant (p-values >0.05) and, especially in the case of glutamine, seemed to be far outweighed by the risk of increased mortality. (Choice C) This study did not address the question of whether oxidative stress plays a role in critical illness, only whether supplementation with antioxidants or glutamine offers therapeutic benefit to critically ill patients. (Choice D) At no point was a mortality benefit seen in either treatment group; therefore, a clinically nonsignificant mortality benefit is unlikely. Educational objective: P-values <0.05 suggest statistical significance.

A 56-Year-Old Man Is Hospitalized in the Intensive Care Unit