Effects of preoperative intravenous glutamine administration on cardiac and renal functions in patients undergoing mitral valve replacement surgeries: A randomized double-blind controlled trial

ABSTRACT

Background

Preoperative poor nutrition greatly raises the risk of complications and increases length of stay (LOS). Glutamine deficiency may impair immune functions, reduce myocardial adenosine triphosphate–adenosine diphosphate (ATP-ADP) substrate and decrease myocardial glutathione level. We evaluated the effects of preoperative glutamine administration in patients undergoing mitral valve replacement surgery upon cardiac and renal outcomes or hospital/ICU LOS.

Methods

This prospective randomized double-blinded study included 60 patients above 18 up to 60 years undergoing mitral valve replacement. For 3 days preoperatively, Group N patients received glutamine intravenously 0.4 g/kg/day while Group C patients received intravenous normal saline as placebo. The primary outcome was to assess the effects of glutamine on cardiac function as reflected on proBNP (brain natriuretic peptide) during 4 postoperative days. Secondary outcomes included renal function, vasoactive inotropic score, duration of mechanical ventilation, and hospital/ICU stays.

Results

Postoperative proBNP was significantly lower in Group N during the entire period. It was significantly decreased on the first postoperative day in both groups in comparison to the preoperative values. No significant changes were recorded regarding renal functions, and duration of mechanical ventilation between groups. Also, there was signifiacant difference between the two studied groups regarding the vasoactive inotropic score at the 12th, 18th, 24th and 48th hours with lower scores in Group N. ICU and hospital stays were significantly lower in Group N than Group C.

Conclusion

Short term of preoperative intravenous glutamine 0.4 g/kg/day decreased the postoperative proBNP level and hospital/ICU stays in mitral valve replacement surgery. No significant implication was reported upon postoperative human NGAL level or kidney functions.

KEYWORDS:

• Glutamine
• immunonutrition
• cardiac function
• brain natriuretic peptide
• open heart surgeries

Acknowledgments

We would like to thank all anesthetists, surgeons, and the intensive care unit nurses involved in the conduct of this trial. Thanks to the great favor of the Faculty of Medicine for supporting this work.

Disclosure statement

The authors declared no conflict of interest with any financial organizations regarding the materials discussed in their manuscript.

Authors’ contributions

Hany Ahmad Ibrahim Elmorabaa: supervision and critical revision of the manuscript. Mohamed F. Mostafa: design the study, writing and editing the manuscript. Emad Zarief Kamel: study design, data entry and statistical analysis. Mohammed Mahmoud Mostafa: surgical procedures and helped in patients’ admission and study conduct. Ragaa Herdan: data revision and writing the manuscript. Mohamed Ismail Seddik: helped in the laboratory measurements. Mostafa Hassanien Bakr: helped in search online and writing the manuscript. Ramy Mostafa Abd El Gawad: This author helped conduct the study and data collection.