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Meta-Analysis
. 2014;2014(12):CD007174.
doi: 10.1002/14651858.CD007174.pub2. Epub 2014 Dec 23.

Immunonutrition as an adjuvant therapy for burns

Hannah B Tan  1 , Stefan Danilla, Alexandra Murray, Ramón Serra, Regina El Dib, Tom O W Henderson, Jason Wasiak
Affiliations
Meta-Analysis

Immunonutrition as an adjuvant therapy for burns

Hannah B Tan et al. Cochrane Database Syst Rev. 2014.

Abstract

Background: With burn injuries involving a large total body surface area (TBSA), the body can enter a state of breakdown, resulting in a condition similar to that seen with severe lack of proper nutrition. In addition, destruction of the effective skin barrier leads to loss of normal body temperature regulation and increased risk of infection and fluid loss. Nutritional support is common in the management of severe burn injury, and the approach of altering immune system activity with specific nutrients is termed immunonutrition. Three potential targets have been identified for immunonutrition: mucosal barrier function, cellular defence and local or systemic inflammation. The nutrients most often used for immunonutrition are glutamine, arginine, branched-chain amino acids (BCAAs), omega-3 (n-3) fatty acids and nucleotides.

Objectives: To assess the effects of a diet with added immunonutrients (glutamine, arginine, BCAAs, n-3 fatty acids (fish oil), combined immunonutrients or precursors to known immunonutrients) versus an isonitrogenous diet (a diet wherein the overall protein content is held constant, but individual constituents may be changed) on clinical outcomes in patients with severe burn injury.

Search methods: The search was run on 12 August 2012. We searched the Cochrane Injuries Group's Specialised Register, The Cochrane Library, MEDLINE (OvidSP), Embase (OvidSP), ISI WOS SCI-EXPANDED & CPCI-S and four other databases. We handsearched relevant journals and conference proceedings, screened reference lists and contacted pharmaceutical companies. We updated this search in October 2014, but the results of this updated search have not yet been incorporated.

Selection criteria: Randomised controlled trials comparing the addition of immunonutrients to a standard nutritional regimen versus an isonitrogenated diet or another immunonutrient agent.

Data collection and analysis: Two review authors were responsible for handsearching, reviewing electronic search results and identifying potentially eligible studies. Three review authors retrieved and reviewed independently full reports of these studies for inclusion. They resolved differences by discussion. Two review authors independently extracted and entered data from the included studies. A third review author checked these data. Two review authors independently assessed the risk of bias of each included study and resolved disagreements through discussion or consultation with the third and fourth review authors. Outcome measures of interest were mortality, hospital length of stay, rate of burn wound infection and rate of non-wound infection (bacteraemia, pneumonia and urinary tract infection).

Main results: We identified 16 trials involving 678 people that met the inclusion criteria. A total of 16 trials contributed data to the analysis. Of note, most studies failed to report on randomisation methods and intention-to-treat principles; therefore study results should be interpreted with caution. Glutamine was the most common immunonutrient and was given in seven of the 16 included studies. Use of glutamine compared with an isonitrogenous control led to a reduction in length of hospital stay (mean stay -5.65 days, 95% confidence interval (CI) -8.09 to -3.22) and reduced mortality (pooled risk ratio (RR) 0.25, 95% CI 0.08 to 0.78). However, because of the small sample size, it is likely that these results reflect a false-positive effect. No study findings suggest that glutamine has an effect on burn wound infection or on non-wound infection. All other agents investigated showed no evidence of an effect on mortality, length of stay or burn wound infection or non-wound infection rates.

Authors' conclusions: Although we found evidence of an effect of glutamine on mortality reduction, this finding should be taken with care. The number of study participants analysed in this systematic review was not sufficient to permit conclusions that recommend or refute the use of glutamine. Glutamine may be effective in reducing mortality, but larger studies are needed to determine the overall effects of glutamine and other immunonutrition agents.

PubMed Disclaimer

Conflict of interest statement

All authors: none known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 All‐cause mortality, Outcome 1 Glutamine vs control.
1.2
1.2. Analysis
Comparison 1 All‐cause mortality, Outcome 2 Ornithine α‐ketoglutarate vs control.
1.3
1.3. Analysis
Comparison 1 All‐cause mortality, Outcome 3 Branched‐chain amino acids vs control.
1.4
1.4. Analysis
Comparison 1 All‐cause mortality, Outcome 4 Fish oil vs control.
1.5
1.5. Analysis
Comparison 1 All‐cause mortality, Outcome 5 Combined immunonutrients vs control.
2.1
2.1. Analysis
Comparison 2 Length of hospital stay, Outcome 1 Glutamine vs control.
2.2
2.2. Analysis
Comparison 2 Length of hospital stay, Outcome 2 Ornithine α‐ketoglutarate vs control.
2.3
2.3. Analysis
Comparison 2 Length of hospital stay, Outcome 3 Branched‐chain amino acids.
2.4
2.4. Analysis
Comparison 2 Length of hospital stay, Outcome 4 Fish oil vs control.
2.5
2.5. Analysis
Comparison 2 Length of hospital stay, Outcome 5 Combined immunonutrients vs control.
3.1
3.1. Analysis
Comparison 3 Rate of burn wound infection, Outcome 1 Glutamine vs control.
3.2
3.2. Analysis
Comparison 3 Rate of burn wound infection, Outcome 2 Ornithine α‐ketoglutarate vs control.
3.3
3.3. Analysis
Comparison 3 Rate of burn wound infection, Outcome 3 Combined immunonutrients vs control.
4.1
4.1. Analysis
Comparison 4 Rate of non‐wound infection, Outcome 1 Glutamine vs control.
4.2
4.2. Analysis
Comparison 4 Rate of non‐wound infection, Outcome 2 Fish oil vs control.
4.3
4.3. Analysis
Comparison 4 Rate of non‐wound infection, Outcome 3 Combined immunonutrients vs control.
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References

References to studies included in this review

Brown 1990 {published data only}
    1. Brown RO, Buonpane EA, Vehe KL, Hickerson WL, Luther RW. Comparison of modified amino acids and standard amino acids in parenteral nutrition support of thermally injured patients. Critical Care Medicine 1990;18(10):1096‐101. - PubMed
Coudray‐Lucas 2000 {published data only}
    1. Coudray‐Lucas C, Bever H, Cynober L, Bandt JP, Carsin H, Coudray‐Lucas C, et al. Ornithine alpha‐ketoglutarate improves wound healing in severe burn patients: a prospective randomized double‐blind trial versus isonitrogenous controls. Critical Care Medicine 2000;28(6):1772‐6. - PubMed
De Bandt 1998 {published data only}
    1. Bandt JP, Coudray‐Lucas C, Lioret N, Lim SK, Saizy R, Giboudeau J, et al. A randomized controlled trial of the influence of the mode of enteral ornithine alpha‐ketoglutarate administration in burn patients. The Journal of Nutrition 1998;128(3):563‐9. - PubMed
Donati 1999 {published data only}
    1. Donati L, Ziegler F, Pongelli G, Signorini MS. Nutritional and clinical efficacy of ornithine alpha‐ketoglutarate in severe burn patients. Clinical Nutrition 1999;18(5):307‐11. - PubMed
Garrel 1995 {published data only}
    1. Garrel DR, Razi M, Lariviere F, Jobin N, Naman N, Emptozbonneton A, et al. Improved clinical status and length of care with low‐fat nutrition support in burn patients. Journal of Parenteral and Enteral Nutrition 1995;19(6):482‐91. - PubMed
Garrel 2003 {published data only}
    1. Garrel D, Patenaude J, Nedelec B, Samson L, Dorais J, Champoux J, et al. Decreased mortality and infectious morbidity in adult burn patients given enteral glutamine supplements: a prospective, controlled, randomized clinical trial. Critical Care Medicine 2003;31(10):2444‐9. - PubMed
Gottschlich 1990 {published data only}
    1. Gottschlich MM, Jenkins M, Warden GD, Baumer T, Havens P, Snook JT, et al. Differential effects of three enteral dietary regimens on selected outcome variables in burn patients.[see comment]. Journal of Parenteral & Enteral Nutrition 1990;14(3):225‐36. - PubMed
Lu 2004 {published data only}
    1. Lu CJ, Lin C, Xu JJ, Zhang P, Cao GZ, Hong BS. [The influence of combined supplementation of glutamine and recombinant human growth hormone on the protein metabolism in severely burned patients]. [Chinese]. Zhonghua Shao Shang Za Zhi 2004;20(4):220‐2. - PubMed
Peng 2004b {published data only}
    1. Peng X, Yan H, You HY, Wang P, Wang SL. Effects of enteral supplementation with glutamine granules on intestinal mucosal barrier function in severe burned patients. Burns 2004;30(2):135‐9. - PubMed
Saffle 1997 {published data only}
    1. Saffle JR, Wiebke G, Jennings K, Morris SE, Barton RG, Saffle JR, et al. Randomized trial of immune‐enhancing enteral nutrition in burn patients. Journal of Trauma‐Injury Infection & Critical Care 1997;42(5):793‐802. - PubMed
Toledo 2007 {published data only}
    1. Toledo J, Danilla S, Leniz P, Pineros J, Fernandez A, Roldan P, et al. Early immunonutrition in moderately burned patients: a prospective, double masked, randomized controlled trial. Burns 2007;33(1 Suppl):s61‐s62. [ZETOC ID: RN200522896]
Wibbenmeyer 2006 {published data only}
    1. Wibbenmeyer LA, Mitchell MA, Newel IM, Faucher LD, Amelon MJ, Ruffin TO, et al. Effect of a fish oil and arginine‐fortified diet in thermally injured patients. Journal of Burn Care & Research 2006;27(5):694‐702. - PubMed
Wischmeyer 2001 {published data only}
    1. Wischmeyer PE, Lynch J, Liedel J, Wolfson R, Riehm J, Gottlieb L, et al. Glutamine administration reduces gram‐negative bacteremia in severely burned patients: a prospective, randomized, double‐blind trial versus isonitrogenous control. Critical Care Medicine 2001;29(11):2075‐80. - PubMed
Zhou 2002 {published data only}
    1. Zhou Y, Sun Y, Jiang Z, He G, Yang N. [The effects of glutamine dipeptide on the improvement of endotoxemia in severely burned patients]. Zhonghua Shao Shang Za Zhi = Zhonghua Shaoshang Zazhi = Chinese Journal of Burns 2002;18(6):343‐5. - PubMed
Zhou 2003 {published data only}
    1. Zhou YP, Jiang ZM, Sun YH, Wang XR, Ma EL, Wilmore D, et al. The effect of supplemental enteral glutamine on plasma levels, gut function, and outcome in severe burns: a randomized, double‐blind, controlled clinical trial. Journal of Parenteral & Enteral Nutrition 2003;27(4):241‐5. - PubMed
Zhou 2004 {published data only}
    1. Zhou YP, Jiang ZM, Sun YH, He GZ, Hong S. The effects of supplemental glutamine dipeptide on gut integrity and clinical outcome after major escharectomy in severe burns: a randomized, double‐blind, controlled clinical trial. Clinical Nutrition 2004;(Suppl 1):55‐60.

References to studies excluded from this review

Abribat 2000 {published data only}
    1. Abribat T, Nedelec B, Jobin N, Garrel DR, Abribat T, Nedelec B, et al. Decreased serum insulin‐like growth factor‐I in burn patients: relationship with serum insulin‐like growth factor binding protein‐3 proteolysis and the influence of lipid composition in nutritional support. Critical Care Medicine 2000;28(7):2366‐72. - PubMed
Alexander 1980 {published data only}
    1. Alexander JWM. Beneficial effects of aggressive protein feeding in severely burned children. Annals of Surgery 1980; Vol. 192, issue 4:505‐17. - PMC - PubMed
Alpers 2006 {published data only}
    1. Alpers DH. Glutamine: do the data support the cause for glutamine supplementation in humans?. Gastroenterology 2006; Vol. 130, issue 2 Suppl:S106‐16. - PubMed
Anisimova 2005 {published data only}
    1. Anisimova IUN, Borovskii VR, Osadchaia OI, Bychkova NG, Ratushniak VV, Klimenko LA, et al. [Effect of additional enteral feeding based on soy suspension on burn wound healing]. [Russian]. Likarska Sprava 2005;5‐6:53‐8. - PubMed
Barbosa 2006 {published data only}
    1. Barbosa RCC, Guimaraes SB, Vasconcelos PRC, Chaves CR, Vasconcelos PRL. Metabolic effects of L‐alanyl‐glutamine in burned rats. Burns 2006;32(6):721‐7. - PubMed
Berger 1996 {published data only}
    1. Berger MM, Spertini F, Shenkin A, Reymond MJ, Schindler C, Tappy L, et al. Clinical, immune and metabolic effects of trace element supplement in burns: a double‐blind placebo‐controlled trial. Clinical Nutrition 1996;15(2):94‐6. [ZETOC ID: RN005778384] - PubMed
Berger 1998 {published data only}
    1. Berger MM, Spertini F, Shenkin A, Wardle C, Wiesner L, Schindler C, et al. Trace element supplementation modulates pulmonary infection rates after major burns: a double‐blind, placebo‐controlled trial. American Journal of Clinical Nutrition 1998;68(2):365‐71. - PubMed
Berger 2003 {published data only}
    1. Berger MM. Nutrients as antioxidants—effect of antioxidative trace elements and vitamins on outcome of critically ill burn and trauma patients. Aktuelle Ernahrungsmedizin 2003; Vol. 28, issue 6:376‐9.
Berger 2006 {published data only}
    1. Berger MM. Antioxidant micronutrients in major trauma and burns: evidence and practice. Nutrition in Clinical Practice 2006; Vol. 21, issue 5:438‐49. - PubMed
Berger 2007 {published data only}
    1. Berger MM, Baines M, Raffoul W, Benathan M, Chiolero RL, Reeves C, et al. Trace element supplementation after major burns modulates antioxidant status and clinical course by way of increased tissue trace element concentrations. The American Journal of Clinical Nutrition 2007;85(5):1293‐300. - PubMed
Berger 2007a {published data only}
    1. Berger MM, Binnert C, Chiolero RL, Taylor W, Raffoul W, Cayeux MC, et al. Trace element supplementation after major burns increases burned skin trace element concentrations and modulates local protein metabolism but not whole‐body substrate metabolism. American Journal of Clinical Nutrition 2007;85(5):1301‐6. - PubMed
Bernier 1998 {published data only}
    1. Bernier J, Jobin N, Emptoz‐Bonneton A, Pugeat MM, Garrel DR. Decreased corticosteroid‐binding globulin in burn patients: relationship with interleukin‐6 and fat in nutritional support. Critical Care Medicine 1998;26(3):452‐60. - PubMed
Cai 2006 {published data only}
    1. Cai C, Guo GH, Xu QL, Tang YZ, Liu S. [Protective effects of enteral immunonutrition on intestinal mucosa injury in burned rats]. [Chinese]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2006;18(10):609‐12. - PubMed
Cen 1999 {published data only}
    1. Cen Y, Luo XS, Liu XX, Cen Y, Luo XS, Liu XX. [Effect of L‐arginine supplementation on partial‐thickness burned patients]. [Chinese]. Chung‐Kuo Hsiu Fu Chung Chien Wai Ko Tsa Chih/Chinese Journal of Reparative & Reconstructive Surgery 1999;13(4):227‐31. - PubMed
Chen 1999 {published data only}
    1. Chen XL, Li YP, Cai XT, Xu WS, Lu SL, Shi JX. Dose‐effect of dietary L‐arginine supplementation on burn wound healing in rats. Chinese Medical Journal 1999;112(9):828‐31. - PubMed
Chen 2001 {published data only}
    1. Chen G, Xie W, Jiang H. [Clinical observation of the protective effect of oral feeding of glutamine granules on intestinal mucous membrane]. Zhonghua Shao Shang Za Zhi = Zhonghua Shaoshang Zazhi = Chinese Journal of Burns 2001;17(4):210‐1. - PubMed
Chen 2006 {published data only}
    1. Chen G‐X Han. Economic evaluation of early enteral nutrition in severely burned patients. Chinese Journal of Clinical Nutrition 2006; Vol. 14, issue 1:7‐10.
Chuntrasakul 1998a {published data only}
    1. Chuntrasakul C, Siltharm S, Sarasombath S, Sittapairochana C, Leowattana W, Chockvivatanavanit S, et al. Metabolic and immune effects of dietary arginine, glutamine and omega‐3 fatty acids supplementation in immunocompromised patients. Journal of the Medical Association of Thailand 1998;81(5):334‐43. - PubMed
Chuntrasakul 2003 {published data only}
    1. Chuntrasakul C, Siltham S, Sarasombath S, Sittapairochana C, Leowattana W, Chockvivatanavanit S, et al. Comparison of a immunonutrition formula enriched arginine, glutamine and omega‐3 fatty acid, with a currently high‐enriched enteral nutrition for trauma patients. Journal of the Medical Association of Thailand = Chotmaihet Thangphaet 2003;86(6):552‐61. - PubMed
Cynober 1984 {published data only}
    1. Cynober L, Saizy R, Nguyen Dinh F, Lioret N, Giboudeau J, Cynober L, et al. Effect of enterally administered ornithine alpha‐ketoglutarate on plasma and urinary amino acid levels after burn injury. Journal of Trauma‐Injury Infection & Critical Care 1984;24(7):590‐6. - PubMed
De Bandt 2006 {published data only}
    1. Bandt J‐PCynober. Therapeutic use of branched‐chain amino acids in burn, trauma, and sepsis. Journal of Nutrition 2006; Vol. 136, issue 1:308S‐13S. - PubMed
Demling 2000 {published data only}
    1. Demling RHS. Metabolic management of patients with severe burns. World Journal of Surgery 2000; Vol. 24, issue 6:673‐80. - PubMed
Dhanraj 1997 {published data only}
    1. Dhanraj P, Chacko A, Mammen M, Bharathi R. Hospital‐made diet versus commercial supplement in postburn nutritional support. Burns 1997;23(6):512‐4. - PubMed
Donati 1983 {published data only}
    1. Donati L, Lazzarin A, Signorini M, Candiani P, Klinger M, Moroni M. Preliminary clinical experiences with the use of immunomodulators in burns. Journal of Trauma 1983;23(9):816‐31. - PubMed
Dunn 2008 {published data only}
    1. Dunn K. The effect of enteral administration of synbiotics upon infection rates in major burns. Current Controlled Trials. [ISRCTN16675260]
Furukawa 1997 {published data only}
    1. Furukawa SS. Glutamine‐enhanced bacterial killing by neutrophils from postoperative patients. Nutrition 1997; Vol. 13, issue 10:863‐9. - PubMed
Garcia‐De‐Lorenzo 2005 {published data only}
    1. Garcia‐De‐Lorenzo A, Denia R, Atlan P, Martinez‐Ratero S, Brun A, Evard D, et al. Parenteral nutrition providing a restricted amount of linoleic acid in severely burned patients: a randomised double‐blind study of an olive oil‐based lipid emulsion v. medium/long‐chain triacylglycerols. British Journal of Nutrition 2005;94(2):221‐30. - PubMed
Garrel 2004 {published data only}
    1. Garrel D. The effect of supplemental enteral glutamine on plasma levels, gut function, and outcome in severe burns. Journal of Parenteral and Enteral Nutrition 2004;28(2):123. - PubMed
Garrel 2004a {published data only}
    1. Garrel D, Patenaude J, Nedelec B. Decreased mortality and infectious morbidity in adult burn patients given enteral glutamine supplements: a prospective, controlled, randomized clinical trial (Vol 31, pp 2444, 2003). Critical Care Medicine 2004;32(2):621. - PubMed
Ge 2003 {published data only}
    1. Ge L, Hou GZ, Huang CB. Observation of the efficacy and safety of L‐glutamine granules in treating severe burn patients. Journal of Chongqing Medical University 2003;28(4):509‐2.
Gore 2005 {published data only}
    1. Gore DCH. Comparison of peripheral metabolic effects of insulin and metformin following severe burn injury. Journal of Trauma—Injury, Infection and Critical Care 2005; Vol. 59, issue 2:316‐23. - PubMed
Griffiths 2001 {published data only}
    1. Griffiths RDA. Glutamine: a life‐threatening deficiency in the critically ill?. Intensive Care Medicine 2001; Vol. 27, issue 1:12‐5. - PubMed
Guo 2007 {published data only}
    1. Guo GH, Cai C, Fan J, Zhang HY, Li GH. [The influence of early enteral immunonutrition on immunological function of body and intestine in severely scalded rats]. [Chinese]. Zhonghua Shao Shang Za Zhi 2007;23(4):257‐60. - PubMed
Hansbrough 1995 {published data only}
    1. Hansbrough JF, Herndon DN, Heimbach DM, Solem LD, Gamelli RL, Tompkins RG. Accelerated healing and reduced need for grafting in pediatric patients with burns treated with arginine‐glycine‐aspartic acid peptide matrix. RGD Study Group. The Journal of Burn Care & Rehabilitation 1995;16(4):377‐87. - PubMed
Herndon 1987 {published data only}
    1. Herndon DN, Stein MD, Rutan TC, Abston S, Linares H. Failure of TPN supplementation to improve liver function, immunity, and mortality in thermally injured patients. The Journal of Trauma 1987;27(2):195‐204. - PubMed
Horton 1998 {published data only}
    1. Horton JW, White J, Maass D, Sanders B. Arginine in burn injury improves cardiac performance and prevents bacterial translocation. Journal of Applied Physiology 1998;84(2):695‐702. - PubMed
Jacobs 2004 {published data only}
    1. Jacobs DG, Jacobs DO, Kudsk KA, Moore FA, Oswanski MF, Poole GV, et al. Practice management guidelines for nutritional support of the trauma patient. Journal of Trauma 2004;57(3):660‐78. - PubMed
Jaffin 1994 {published data only}
    1. Jaffin AJW. Nutritional support of the burned patient. Problems in General Surgery 1994; Vol. 11, issue 4:590‐606.
Jenkins 1994 {published data only}
    1. Jenkins ME, Gottschlich MM, Warden GD. Enteral feeding during operative procedures in thermal injuries. The Journal of Burn Care & Rehabilitation 1994;15(2):199‐205. - PubMed
Jiang 2002a {published data only}
    1. Jiang H, Jiang ZM, Luo B, Shuai X, Li YP. [An appraisal of immunonutrition for clinical nutritional support with a systematic review of English and Chinese documents]. [Chinese]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2002;24(6):552‐8. - PubMed
Juang 2007 {published data only}
    1. Juang P, Fish DN, Jung R, Maclaren R. Enteral glutamine supplementation in critically ill patients with burn injuries: a retrospective case‐control evaluation. Pharmacotherapy 2007;27(1):11‐9. - PubMed
King 1990 {published data only}
    1. King P, Power DM. Branched chain amino/keto acid supplementation following severe burn injury: a preliminary report. Clinical Nutrition 1990;9(4):226‐30. - PubMed
Krenitsky 2006 {published data only}
    1. Krenitsky J. Immunonutrition—Fact, fancy or folly?. Practical Gastroenterology 2006; Vol. 30, issue 5:47‐68.
Kreymann 2006 {published data only}
    1. Kreymann KGB. ESPEN guidelines on enteral nutrition: intensive care. Clinical Nutrition 2006; Vol. 25, issue 2:210‐23. - PubMed
L‐arginine {published data only}
    1. Anonymous. L‐arginine: monograph. Alternative Medicine Review 2005;10(2):139‐48. - PubMed
Le 1997 {published data only}
    1. Bricon T, Coudray‐Lucas C, Lioret N, Lim SK, Plassart F, Schlegel L, et al. Ornithine alpha‐ketoglutarate metabolism after enteral administration in burn patients: bolus compared with continuous infusion. American Journal of Clinical Nutrition 1997;65(2):512‐8. - PubMed
Le 1999 {published data only}
    1. Boucher J, Farges MC, Minet R, Vasson MP, Cynober L. Modulation of immune response with ornithine alpha‐ketoglutarate in burn injury: an arginine or glutamine dependency?. Nutrition 1999;15(10):773‐7. - PubMed
Leboucher 1997 {published data only}
    1. Leboucher J, Coudraylucas C, Lasnier E, Jardel A, Ekindjian OG, Cynober LA. Enteral administration of ornithine alpha‐ketoglutarate or arginine alpha‐ketoglutarate: a comparative study of their effects on glutamine pools in burn‐injured rats. Critical Care Medicine 1997;25(2):293‐8. - PubMed
Liljedahl 1982 {published data only}
    1. Liljedahl SO, Larsson J, Schildt B, Vinnars E. Metabolic studies in severe burns. Clinical features, routine biochemical analyses, nitrogen balance and metabolic rate. Acta Chirurgica Scandinavica 1982;148(5):393‐400. [PUBMED: 6817568] - PubMed
Lu 1993 {published data only}
    1. Lu SL, Lu SL. [Effect of arginine supplementation on T‐lymphocyte function in burn patients] [Chinese]. Chung‐Hua Cheng Hsing Shao Shang Wai Ko Tsa Chih/Chinese Journal of Plastic Surgery & Burns 1993;9(5):368‐71. - PubMed
Lu 2003 {published data only}
    1. Lu SL, Jin SW, Zhang J, Shigeo I, Hideaki S, Liao ZJ, et al. [An experimental study on the effects of postburn dietary supplementation of enhanced nutrients] [Chinese]. Zhonghua Shao Shang Za Zhi 2003;19(4):197‐201. - PubMed
Lu 2005 {published data only}
    1. Lu SL, Ge K, Xie T, Jin SW, Shi JX. [Influence of L‐arginine supplementation on the plasma amino acid spectrum in burn patients] [Chinese]. Zhonghua Shao Shang Za Zhi 2005;21(4):247‐50. - PubMed
Lu 2006 {published data only}
    1. Lu C‐J Yang. Effects of glutamine dipeptide on T‐lymphocyte subgroups in severely burned patients. Chinese Journal of Clinical Nutrition 2006; Vol. 14, issue 1:15‐7.
Lu 2006a {published data only}
    1. Lu SJ, Peng X, Zhang Y, Sun Y, You ZY. [Effects of glutamine given through different avenues on intestine mucosal barrier function in burned rats] [Chinese]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2006;18(10):619‐22. - PubMed
Manelli 1984 {published data only}
    1. Manelli JC, Garabedian M. Effects on muscle and whole body protein breakdown of a branched chain amino acid enriched solution in burn patients [Effets sur la proteolyse musculaire et generale du brule d'une solution enrichie en acides amines ramifies]. Annales Francaise d'Anesthesie et de Reanimation 1984;3(4):256‐60. - PubMed
Manelli 1984c {published data only}
    1. Manelli JC, Garabedian M, Rose F, Ounis N, Houvenaeghel M. Effects of branched chain amino acids upon nitrogen loss and muscle protein breakdown in burn patients. Clinical Nutrition 1984; Vol. 2, issue (Spec Suppl).
Marin 2002 {published data only}
    1. Marin VB, Rodriguez‐Osiac L, Schlesinger L, Villegas J, Marcelo L, Castillo‐Duran C. Controlled study of enteral arginine‐supplementation in burned children: immunological and metabolic effect. Pediatric Research 2002;51(4):189A.
Marin 2003 {published data only}
    1. Marin BV, Rodriguez‐Osiac L, Castillo‐Duran C, Schlesinger L, Villegas J, Lopez M, et al. Controlled study of arginine‐supplemented diet in burn pediatric patients: immunological and metabolic effect. Pediatric Research 2003;53(5):872.
Marin 2006 {published data only}
    1. Marin VB, Rodriguez‐Osiac L, Schlessinger L, Villegas J, Lopez M, Castillo‐Duran C. Controlled study of enteral arginine supplementation in burned children: impact on immunologic and metabolic status. Nutrition (Burbank, Los Angeles County, CA) 2006;22(7‐8):705‐12. - PubMed
Mayes 2008 {published data only}
    1. Mayes T, Gottschlich MM, Kagan RJ, Mayes Theresa, Gottschlich Michele M, Kagan Richard J. An evaluation of the safety and efficacy of an anti‐inflammatory, pulmonary enteral formula in the treatment of pediatric burn patients with respiratory failure. Journal of Burn Care & Research 2008;29(1):82‐8. - PubMed
Melis 2004 {published data only}
    1. Melis GCW. Glutamine: recent developments in research on the clinical significance of glutamine. Current Opinion in Clinical Nutrition and Metabolic Care 2004; Vol. 7, issue 1:59‐70. - PubMed
Montejo 2003a {published data only}
    1. Montejo JCZ. Immunonutrition in the intensive care unit. A systematic review and consensus statement. Clinical Nutrition 2003; Vol. 22, issue 3:221‐33. - PubMed
Murakami 2007 {published data only}
    1. Murakami K, Enkhbaatar P, Yu YM, Traber LD, Cox RA, Hawkins HK, et al. L‐arginine attenuates acute lung injury after smoke inhalation and burn injury in sheep. Shock 2007;28(4):477‐83. - PubMed
NCT00181753 {published data only}
    1. NCT00181753. Study of Glutamate and Glutamine Metabolism in Burn Patients Receiving Enteral or Parenteral Nutrition. http://clinicaltrials.gov/show/NCT00181753 2009. [NCT00181753]
NCT00216970 {published data only}
    1. NCT00216970. Study of Arginine Metabolism and Nitric Oxide Formation in Relation to Glutamine Supply in Severely Burned Patients. http://clinicaltrials.gov/show/NCT00216970 1997. [NCT00216970]
NCT00216983 {published data only}
    1. NCT00216983. Proline Metabolism in Severely Burned Patients: Effect of Modulated Parenteral Feeding. http://clinicaltrials.gov/show/NCT00216983 1997. [NCT00216983]
NCT00216996 {published data only}
    1. NCT00216996. Study on the Effect of Glutamine Supplemented Nutrition Support on Protein and Glutamine Metabolism in Severely Burned Patients. http://clinicaltrials.gov/show/NCT00216996 1997. [NCT00216996]
NCT00217035 {published data only}
    1. NCT00217035. Glutamine Enriched Total Parenteral Feeding and Proline Metabolism in Severely Burned Patients. http://clinicaltrials.gov/show/NCT00217035 1997. [NCT00217035]
NCT00536276 {published data only}
    1. NCT00536276. Evaluation of Vitamin D Status in Children With Acute Burns (Vitamin D). http://clinicaltrials.gov/show/NCT00536276 2008. [NCT00536276]
Ogle 1994 {published data only}
    1. Ogle CK, Ogle JD, Mao JX, Simon J, Noel JG, Li BG, et al. Effect of glutamine on phagocytosis and bacterial killing by normal and pediatric burn patient neutrophils. Journal of Parenteral & Enteral Nutrition 1994 Mar‐Apr;18(2):128‐33. [DOI: ] - PubMed
Pacifico 2005 {published data only}
    1. Pacifico SLL. Glutamine supplementation: is it beneficial to critically ill children?. Revista de Nutricao 2005; Vol. 18, issue 1:95‐104.
Peck 2004 {published data only}
    1. Peck MD, Kessler M, Cairns BA, Chang YH, Ivanova A, Schooler W, et al. Early enteral nutrition does not decrease hypermetabolism associated with burn injury. Journal of Trauma—Injury Infection & Critical Care 2004;57(6):1143‐8. - PubMed
Peng 2004 {published data only}
    1. Peng X, You ZY, Huang XK, Zhang CQ, He GZ, Xie WG, et al. [Analysis of the therapeutic effect and the safety of glutamine granules per os in patients with severe burns and trauma] [Chinese]. Zhonghua Shao Shang Za Zhi 2004;20(4):206‐9. - PubMed
Peng 2004a {published data only}
    1. Peng X, You ZY, Huang XK, Zhang SQ, He GZ, Xie WG, et al. [Effects of glutamine granules on protein metabolism in trauma patients]. Zhonghua Wai Ke Za Zhi [Chinese Journal of Surgery] 2004;42(7):406‐9. - PubMed
Peng 2004c {published data only}
    1. Peng X, Yan H, You Z, Wang P, Zhao Y, Wang S. Analysis of efficacy and safety of glutamine granules in severely burned patients. Annals of Burns and Fire Disasters 2004 June;XVII(2):77‐80.
Peng 2005 {published data only}
    1. Peng X, You ZY, Huang XK, Zhang CQ, He GZ, Quan ZF, et al. [Effects of glutamine granules on immunofunction in trauma patients: a double‐blind randomized controlled, multi‐center clinical trail with 120 patients]. Zhonghua wai ke za zhi [Chinese journal of surgery] 2005;43(17):1123‐6. - PubMed
Peng 2005a {published data only}
    1. Peng X, Yan H, You Z, Wang P, Wang S. Clinical and protein metabolic efficacy of glutamine granules‐supplemented enteral nutrition in severely burned patients. Burns : journal of the International Society for Burn Injuries 2005;31(3):342‐6. - PubMed
Peng 2005b {published data only}
    1. Peng X, You ZY, Huang XK, Zhang CQ, He GZ, Quan ZF, et al. [Effects of glutamine granules on immunofunction in trauma patients: a double‐blind randomized controlled, multi‐center clinical trail with 120 patients]. [Chinese]. Chung‐Hua Wai Ko Tsa Chih [Chinese Journal of Surgery] 2005;43(17):1123‐6. - PubMed
Peng 2006 {published data only}
    1. Peng X, Yi D, Fan SZ, Liao ZJ, Yao YZ, Cong TQ, et al. [Analysis of the influence on the prognosis and safety of arginine in patients with severe trauma and burns—a multi‐center randomized double blinded, placebo controlled, clinical trail in 86 patients] [Chinese]. Zhonghua Shao Shang Za Zhi 2006;22(4):243‐6. - PubMed
Peng 2006a {published data only}
    1. Peng X, Yan H, You Z, Wang P, Wang S, Peng Xi, et al. Glutamine granule‐supplemented enteral nutrition maintains immunological function in severely burned patients. Burns 2006;32(5):589‐93. - PubMed
Purdue 2007 {published data only}
    1. Purdue GF. American Burn Association Presidential Address 2006 on Nutrition: Yesterday, Today, and Tomorrow. Journal of Burn Care & Research 2007;28(1):1‐5. - PubMed
Rimdeika 2006 {published data only}
    1. Rimdeika R, Gudaviciene D, Adamonis K, Barauskas G, Pavalkis D, Endzinas Z, et al. The effectiveness of caloric value of enteral nutrition in patients with major burns. Burns 2006;32(1):83‐6. - PubMed
Saffle 2003 {published data only}
    1. Saffle JR. What's new in general surgery: burns and metabolism. Journal of the American College of Surgeons 2003; Vol. 196, issue 2:267‐89. - PubMed
Sheridan 2004 {published data only}
    1. Sheridan RL, Prelack K, Yu YM, Lydon M, Petras L, Young VR, et al. Short‐term enteral glutamine does not enhance protein accretion in burned children: a stable isotope study. Surgery 2004;135(6):671‐8. - PubMed
Taylor 1999 {published data only}
    1. Taylor SJ. Early enhanced enteral nutrition in burned patients is associated with fewer infective complications and shorter hospital stay. Journal of Human Nutrition and Dietetics 1999;12(2):85‐91.
Wilmore 2001 {published data only}
    1. Wilmore DW. The effect of glutamine supplementation in patients following elective surgery and accidental injury. Journal of Nutrition 2001;131(Suppl 9):2543S‐9S. - PubMed
Windle 2006a {published data only}
    1. Windle EM. Glutamine supplementation in critical illness: evidence, recommendations, and implications for clinical practice in burn care. Journal of Burn Care & Research 2006;27(6):764‐72. - PubMed
Wischmeyer 2005 {published data only}
    1. Wischmeyer PE. Can glutamine turn off the motor that drives systemic inflammation?. Critical Care Medicine 2005; Vol. 33, issue 5:1175‐8. - PubMed
Yan 2005 {published data only}
    1. Yan H, Peng X, Wang P, Huang YS, Wang SL. [Influence of the enteral feeding of levorotatory arginine on severely burned patients during shock stage] [Chinese]. Zhonghua Shao Shang Za Zhi 2005;21(4):251‐4. - PubMed
Yan 2007 {published data only}
    1. Yan H, Peng X, Huang YS, Zhao MY, Li FY, Wang P. Effects of early enteral arginine supplementation on resuscitation of severe burn patients. Burns 2007;33(2):179‐84. - PubMed
Yu 1988 {published data only}
    1. Yu YM, Wagner DA, Walesreswski JC, Burke JF, Young VR. A kinetic study of leucine metabolism in severely burned patients. Comparison between a conventional and branched‐chain amino acid‐enriched nutritional therapy. Annals of Surgery 1988;207(4):421‐9. [PUBMED: 3128190] - PMC - PubMed
Yu 1995 {published data only}
    1. Yu YM, Young VR, Castillo L, Chapman TE, Tompkins RG, Ryan CM, et al. Plasma arginine and leucine kinetics and urea production rates in burn patients. Metabolism: Clinical & Experimental 1995;44(5):659‐66. - PubMed
Yu 2001 {published data only}
    1. Yu YM, Ryan CM, Castillo L, Lu XM, Beaumier L, Tompkins RG, et al. Arginine and ornithine kinetics in severely burned patients: increased rate of arginine disposal. American Journal of Physiology Endocrinology and Metabolism 2001;280(3):E509‐17. - PubMed

References to studies awaiting assessment

Badetti 1994 {published data only}
    1. Badetti C, Cynober L, Bernini V, Garabedian M, Manelli JC, Badetti C, et al. [Nutrition proteins and muscular catabolism in severely burnt patients. Comparative effects of small peptides or free amino acids] [erratum appears in Annales Francaises d'Anesthesie et de Reanimation 1994;13(6):797] [French]. Annales Francaises d'Anesthesie et de Reanimation 1994;13(5):654‐62. - PubMed
Blass 2012 {published data only}
    1. Blass SC, Goost H, Tolba RH, Stoffel‐Wagner B, Kabir K, Burger C, et al. Time to wound closure in trauma patients with disorders in wound healing is shortened by supplements containing antioxidant micronutrients and glutamine: a PRCT. Clinical Nutrition 2012;4:469‐75. - PubMed
Chakravarty 2002 {published data only}
    1. Chakravarty VIM, Markandayalu M, Lakshmi V, Chacko A, Malleshi NG. Glutamine, fish oil and probiotic: anabolic and immunomodulatory nutrients in enteral food for burn patients. The American Journal of Clinical Nutrition 2002;75(2S):374S.
Chuntrasakul 1998b {published data only}
    1. Chuntrasakul C, Sarasonibath S, Siliharm S, Leowaltana W, Chockviwatwanich S, Sitlapairochna C, et al. A randomized controlled study of arginine, glutamine, and omega‐3 fatty acids enriched enteral diet and specialized high stressed enteral diet in immunocompromised burn patients. Thai Journal of Surgery 1998;19(1):40.
Chuntrasakul 1999 {published data only}
    1. Chuntrasakul C. A randomized controlled study of arginine, glutamine, and omega‐3 fatty acids enriched enteral diet and specialized high stressed enteral diet in immunocompromised injured patients. Thai Journal of Surgery 1999;20(1):25‐6.
Cucereanu‐Badica 2013 {published data only}
    1. Cucereanu‐Badica I, Luca I, Negres S, Grintescu I, Lascar I. The effects of intravenous glutamine supplementation in severely burned, multiple traumatized patients. Farmacia 2013;61(1):212‐9.
Hartman 1994 {published data only}
    1. Hartman KR, Cioffi WG, Schoene NW, Drost A, Carrougher GJ, Wright DG. Neutrophil and plasma lipids in patients with severe burns: effects of 3 fatty acid substitution in enteral feeding formulas. Blood 1994;84:136a.
Heyland 2013 {published data only}
    1. Heyland D, Muscedere J, Wischmeyer PE, Cook D, Jones G, Albert M, et al. A randomized trial of glutamine and antioxidants in critically ill patients. The New England Journal of Medicine 2013;16:1489‐97. - PubMed
Kesey 2013 {published data only}
    1. Kesey J, Dissanaike S. A protocol of early aggressive acceleration of tube feeding increases ileus without perceptible benefit in severely burned patients. Journal of Burn Care & Research 2013;34(5):515‐20. - PubMed
Lekmanov 2013 {published data only}
    1. Lekmanov AU, Erpuleva UV, Zolkina IV, Rossaus PA. Study of glutamine solution use efficiency in pediatric patients with heavy thermic burns and concomitant injuries in the intensive care unit. Anesteziologiia i Reanimatologiia 2013;1:49‐51. - PubMed
Liljedahl 1972 {published data only}
    1. Liljedahl SO. Treatment of burns at the Karolinska Hospital. Int Z Vitam Ernahrungsforsch Beih 1972;12:184‐96. [PUBMED: 4199448] - PubMed
Najmi 2014 {published data only}
    1. Najmi M, Vahdat Shariatpanahi Z, Tolouei M, Amiri Z. Effect of oral olive oil on healing of 10‐20% total body surface area burn wounds in hospitalized patients. Burns 2014:[Epub ahead of print]. [CRS: 7400131000018557; 7400131000018557; PUBMED: 25306088] - PubMed
NCT00561210 {published data only}
    1. NCT00561210. Effect of Early Enteral Tube Feeding Nutrition With an Immune Enhancing Diet in Severe Burn Patients. clinicaltrials.gov/show/NCT00561210.
Pattanshetti 2009 {published data only}
    1. Pattanshetti VM, Powar RS, Godhi AS, Metgud SC. Enteral glutamine supplementation reducing infectious morbidity in burns patients: a randomised controlled trial. Indian Journal of Surgery 2009;71(4):193‐7. - PMC - PubMed
Peng 2001 {published data only}
    1. Peng X, Wang FJ, You ZY, Jie WG. Random pairs and double‐blind study of glutamine on protein metabolism in severe burn. Acta Academiae Medicinae Militaris Tertiae 2001;23(12):1393‐5.
Pérez‐Bárcena 2012 {published data only}
    1. Pérez‐Bárcena J, Marsé P, Cervera M, Frontera G, Llompart‐Pou JA, Raurich JM, et al. Efficacy of the dipeptide N(2)‐L‐Alanyl‐L‐glutamine in traumatic patients admitted to the ICU: a prospective, randomized, double‐blind, multicentre study. Nutrición Hospitalaria 2012;1:116‐22. - PubMed
Petrovskii 1969 {published data only}
    1. Petrovskii KS, Bedulevich TS, Lipatkina LA. Free amino acids in the blood serum of burn patients and changes in their content under the effect of glutamic acid. Vopr Pitan 1969;28(3):12‐7. [PUBMED: 5367258] - PubMed
Sun 2013 {published data only}
    1. Sun Y, Wang LX, Zhou YF, Sun SG, Mao XF, Deng XD, et al. Effects of glutamine combined with ulinastatin on inflammatory response of patients with severe burn injury. Zhonghua Shao Shang Za Zhi 2013;29(4):349‐54. - PubMed
Vivic 2013 {published data only}
    1. Vicic VK, Radman M, Kovacic V. Early initiation of enteral nutrition improves outcomes in burn disease. Asia Pacific Journal of Clinical Nutrition 2013;22(4):543‐7. - PubMed
Zhou 1999 {published data only}
    1. Zhou Y, Jiang Z, Sun Y. [Glutamine dipeptide enriched enteral nutrition improving gut permeability in severe burns]. Zhonghua Yi Xue Za Zhi 1999;79(11):825‐7. - PubMed
Zhou 2002a {published data only}
    1. Zhou YP, Liu W, Jiang ZM, Liu YW. Glutamine dipeptide enriched enteral nutrition on gut barrier function in severe burns. Journal of Parenteral and Enteral Nutrition 2002;23(5):S160.

Additional references

Beale 1999
    1. Beale RJ, Bryg DJ, Bihari DJ. Immunonutrition in the critically ill: a systematic review of clinical outcome. Critical Care Medicine 1999;27(12):2799‐805. - PubMed
Bone 1996
    1. Bone RC. A personal experience with SIRS and MODS. Critical Care Medicine 1996;24(8):1417–8. - PubMed
Bone 1996a
    1. Bone RC. Sir Isaac Newton, sepsis, SIRS, and CARS. Critical Care Medicine 1996;24(7):1125–8. - PubMed
Bower 1986
    1. Bower RH, Muggia‐Sullam M, Vallgren S, Hurst JM, Kern KA, LaFrance R, et al. Branched chain amino acid‐enriched solutions in the septic patient. A randomized, prospective trial. Annals of Surgery 1986;203(1):13‐20. - PMC - PubMed
Calder 2003
    1. Calder PC. Immunonutrition. BMJ 2003;327(7407):117‐8. - PMC - PubMed
Calder 2006
    1. Calder PC. Branched‐chain amino acids and immunity. The Journal of Nutrition 2006;136(1):288S‐93S. - PubMed
Chiarelli 1990
    1. Chiarelli A, Enzi G, Casadei A, Baggio B, Valerio A, Mazzoleni F. Very early nutrition supplementation in burned patients. American Journal of Clinical Nutrition 1990;51(6):1035‐9. - PubMed
Choudhry 2003
    1. Choudhry MA, Haque F, Khan M, Fazal N, Al‐Ghoul W, Ravindranath T, et al. Enteral nutritional supplementation prevents mesenteric lymph node T‐cell suppression in burn injury. Critical Care Medicine 2003;31(6):1764‐70. - PubMed
Cynober 1984
    1. Cynober L, Vaubourdolle M, Dore A, Giboudeau J. Kinetics and metabolic effects of orally administered ornithine alpha‐ketoglutarate in healthy subjects fed with a standardized regimen. American Journal of Clinical Nutrition 1984;39(4):514‐9. - PubMed
Danilla 2009
    1. Danilla S, Wasiak J, Searle S, Arriagada C, Pedreros C, Cleland H, et al. Methodological quality of randomised controlled trials in burns care. A systematic review. Burns 2009;35(7):956‐61. - PubMed
DerSimonian 1986
    1. DerSimonian R, Laird N. Meta‐analysis in clinical trials. Controlled Clinical Trials 1986;7(3):177‐88. - PubMed
Heyland 2001
    1. Heyland DK, Novak F, Drover JW, Jain M, Su X, Suchner U. Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. JAMA 2001;286(8):944‐53. - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analysis. BMJ 2003;327(7414):557‐60. - PMC - PubMed
Higgins 2011a
    1. Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. www.cochrane‐handbook.org.
Higgins 2011b
    1. Sterne JAC, Egger M, Moher D (editors). Chapter 10: Addressing reporting biases. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. www.cochrane‐handbook.org.
Inaba 2005
    1. Inaba R, Mirbod SM, Sugiura H. Effects of Maharishi Amrit Kalash 5 as an Ayurvedic herbal food supplement on immune functions in aged mice. BMC Complementary and Alternative Medicine 2005;25:8. - PMC - PubMed
Jeschke 2008
    1. Jeschke MG, Chinkes DL, Finnerty CC, Kulp G, Suman OE, Norbury WB, et al. Pathophysiologic response to severe burn injury. Annals of Surgery 2008;248:387‐401. - PMC - PubMed
Jiang 2002
    1. Jiang H, Jiang ZM, Luo B, Shuai X, Li YP. [An appraisal of immunonutrition for clinical nutritional support with a systematic review of English and Chinese documents]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2002;24(6):552‐8. - PubMed
Kurmis 2010
    1. Kurmis R, Parker A, Greenwood J. The use of immunonutrition in burn injury care: where are we?. Journal of Burn Care & Research 2010;31:677‐91. [DOI: 10.1097/BCR.0b013e3181eebf01] - DOI - PubMed
Lam 2008
    1. Lam NN, Tien NG, Khoa CM. Early enteral feeding for burned patients: an effective method which should be encouraged in developing countries. Burns 2008;34:192‐6. - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. www.cochrane‐handbook.org.
Li 1995
    1. Li X, Xiang J, Liao Z. [Statistical analysis of 4,547 burn patients and the mortality in different periods]. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 1995;11(5):335‐8. - PubMed
Mayer 2008
    1. Mayer K, Seeger W. Fish oil in critical illness. Current Opinion in Clinical Nutrition and Metabolic Care 2008;11:121‐7. - PubMed
Merrell 1989
    1. Merrell SW, Saffle JR, Larson CM, Sullivan JJ. The declining incidence of fatal sepsis following thermal injury. The Journal of Trauma 1989;29(10):1362‐6. - PubMed
Mochizuki 1984
    1. Mochizuki H, Trocki O, Dominioni L, Brackett KA, Joffe SN, Alexander JW. Mechanism of prevention of postburn hypermetabolism an catabolism by early enteral feeding. Annals of Surgery 1984;200:297‐310. - PMC - PubMed
Montejo 2003
    1. Montejo JC, Zarazaga A, Lopez‐Martinez J, Urrutia G, Roque M, Blesa AL, et al. Immunonutrition in the intensive care unit. A systematic review and consensus statement. Clinical Nutrition 2003;22(3):221‐33. - PubMed
Peter 2005
    1. Peter JV, Moran JL, Phillips‐Hughes J. A metaanalysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients. Critical Care Medicine 2005;33(1):213‐20. [PUBMED: 15644672] - PubMed
Preiser 2003
    1. Preiser JC, Wernerman J. Glutamine, a life‐saving nutrient, but why?. Critical Care Medicine 2003;31(10):2555‐6. - PubMed
Prelack 2007
    1. Prelack K, Dylewski M, Sheridan RL. Practical guidelines for nutritional management of burn injury and recovery. Burns 2007;33(1):14‐24. - PubMed
Rousseau 2013
    1. Rousseau AF, Losser MR, Ichai C, Berger MM. ESPEN endorsed recommendations: nutritional therapy in major burns. Clinical Nutrition 2013;32(4):497‐502. - PubMed
Schloerb 2001
    1. Schloerb P. Immune‐enhancing diets: products, components and their rationales. Journal of Parenteral and Enteral Nutrition 2001;25(2):S3‐7. - PubMed
Schneid 2003
    1. Schneid C, Bandt JP, Cynober L, Torres E, Reach G, Darquy S. In vivo induction of insulin secretion by ornithine alpha‐ketoglutarate: involvement of nitric oxide and glutamine. Metabolism 2003;52(3):344‐50. - PubMed
Seth 2004
    1. Seth SD, Sharma B. Medicinal plants in India. Indian Journal of Medical Research 2004;120(1):9‐11. - PubMed
Sharma 2006
    1. Sharma BR, Harish D, Singh VP, Bangar S. Septicemia as a cause of death in burns: an autopsy study. Burns 2006;32(5):545‐9. - PubMed
SIGN 2010
    1. Scottish Intercollegiate Guidelines Network (SIGN). Search filters. http://www.sign.ac.uk/methodology/filters.html#random.
Tang 1999
    1. Tang H, Zhaofan X, Liu S, Chen Y, Ge S. The experience in the treatment of patients with extensive full‐thickness burns. Burns 1999;25(8):757‐9. - PubMed
Venter 2007
    1. Venter M, Rode H, Sive A, Visser M. Enteral resuscitation and early enteral feeding in children with major burns effect on McFarlane response to stress. Burns 2007;33:464‐71. - PubMed
WHO 2014a
    1. World Health Organization. Burns Factsheet. www.who.int/mediacentre/factsheets/fs365/en (updated April 2014).
WHO 2014b
    1. World Health Organization. Global Health Observatory Data (2011 data). http://apps.who.int/gho/data/node.main.GHECOD?lang=en (accessed 19 April 2014).
Windle 2006
    1. Windle EM. Glutamine supplementation in critical illness: evidence, recommendations, and implications for clinical practice in burn care. Journal of Burn Care & Research 2006;27(6):764‐72. - PubMed
Wischmeyer 2006
    1. Wischmeyer PE. The glutamine story: where are we now?. Current Opinion in Critical Care 2006;12(2):142‐8. - PubMed
Yurt 2001
    1. Yurt R. Burns. In: Norton JA, Barie PS, Bollinger RR, Chang AE, Lowry SF, Mulvihill SJ, et al. editor(s). Surgery: Basic Science and Clinical Evidence. New York: Springer‐Verlag, 2001:327‐40.

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