Nutrition Support Blog: Update from CNW--Clinical Trials Plenary Session: All about REDOXs
February 11, 2013
Thanks to our teammate, Kendra Glassman, for sharing this update from Clinical Nutrition Week! To see this blog and other updates from CNW, visit the ASPEN Connect page of the ASPEN website (http://community.nutritioncare.org/Home) and view all the Recent Blogs.
Clinical Trials Plenary Session: All about REDOXs
Anticipation was high for the results of the REDOXs trial which evaluated the effects of high dose glutamine and antioxidant supplementation on mortality in a large scale randomized trial in adult critically ill patients with multiple organ failure. Given the positive results from recent meta-analyses in regards to decreased mortality with glutamine and/or antioxidant supplementation expectations were high for the REDOXs trial (1,2). Although other studies were discussed, the room was filled with practitioners anxiously awaiting the results of the trial by Dr. Heyland.
Patients were randomized to receive glutamine or antioxidant supplementation or placebo. Glutamine was given parenterally at a dose of 0.35 grams/kg/day and 30 grams/day enterally. Antioxidants provided included 500 mcg of parenteral selenium and the following vitamins and minerals enterally: Selenium 300 µg, Beta Carotene 10 mg, Vitamin E 500 mg, and Vitamin C 1500 mg. The Canadian clinical practice guidelines for nutrition support were followed with enteral nutrition started as soon as possible.
OK, OK, I will not leave you in anticipation any longer! To everyone’s surprise, including Heyland himself, the trial showed an increase, yes increase, in mortality with glutamine supplementation. A subgroup analysis revealed patients with the highest SOFA scores, on high dose vasopressors, and those with renal failure had the highest mortality rates. Mortality rates were not significantly different in the group randomized to the antioxidant group.
Although the results of this trial were not expected and disappointing, it reminds us once again we cannot jump on the intervention bandwagon without strong evidence from well-designed randomized control trials. It is easy to want to “fix” our patients with nutrition, however caution must be utilized with routine supplementation of novel antioxidant admixtures until more robust data is available.
1. Heyland DK, Dhaliwal R, Suchner U, Berger MM. Antioxidant nutrients: a systematic review of trace elements and vitamins in the critically ill patient. Intensive Care Med. 2005 Mar;31(3):327-37. Epub 2004 Dec 17. Review.
2. Novak F, Heyland DK, Avenell A, Drover JW, Su X. Glutamine supplementation in serious illness: a systematic review of the evidence. Crit Care Med. 2002 Sep;30(9):2022-9. Review.