Background Intravenous glutamine supplementation in patients with catabolic stress is widespread in clinical practise, although there is no clear consensus on its use.
Purpose To study the use of glutamine in adult parenteral nutrition to adapt it to the available scientific evidence and to assess the economic impact of parenteral nutritional treatment.
Materials and Methods Retrospective observational study of units of parenteral nutrition (PNU) produced during 2011.
We studied the three services that used PN most: Digestive Surgery, Digestive and Intensive Care Unit (ICU).
Data collection source: Software in parenteral nutrition area. Pharmacy Management System.
Protocols produced by service (number of each PNU protocol, protocol type, number of patients with each protocol and duration of nutrition).
Individualized PNUs produced by service (number of PNUs, number of patients and duration of PN).
Cost of each protocol and glutamine cost therein.
Results Of all adult PNUs produced in accordance with a protocol, 58% were stress protocols.
PNU per service (including individual):
Digestive Surgery: 80% of the total number of PNUs were stress PNU and corresponded to 68% of the patients. There is scientific evidence to recommend the use of glutamine in patients undergoing major abdominal surgery.
Digestive: 52% of the total number of PNUs were stress PNU and corresponded to 54% of the patients. Glutamine use was associated with acute pancreatitis and inflammatory disease, although clinical studies are insufficient to recommend this.
ICU: 63% of the total number of PNUs were stress PNU and corresponded to 72% of patients. There is evidence of clinical benefit with high recommendation.
Glutamine cost varies between 45.4%–55.7% of the total cost per PNU.
76.5% of the total cost of protocolized PNUs corresponded to stress protocols.
Conclusions An opportunity for improvement is identified in the use of glutamine. We propose a detailed study of the prescription/indication to rationalise its high use and associated costs.
No conflict of interest.
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