A Randomized Controlled Trial of the Influence of the Mode of Enteral Ornithine -Ketoglutarate Administration in Burn Patients

Manuscript received 29 October 1996. Initial reviews completed 16 December 1996. Revision accepted 18 May 1997.

Jean-Pascal De Bandt^*, , Colette Coudray-Lucas^*, Nicole Lioret, Soo Kyung Lim^*, Robert Saizy, Jacqueline Giboudeau^*, and Luc Cynober^*,

^* Laboratoire de Biochimie A and  Service des Brûlés, Hôpital Saint Antoine, 75571 Paris Cedex 12, France

To investigate appropriate mode and daily dose of enteral ornithine -ketoglutarate (OKG) administration, 54 burn patients (total burn surface area: 20-50%) were included in a randomized controlled trial and assigned to receive either a supplement of OKG (10, 20 or 30 g/d) as bolus or continuous infusion, or a continuous infusion of an isonitrogenous amount of a soy protein mixture (Protil-1: 10, 20 or 30 g/d) in addition to their enteral diet. The influence of these treatments on clinical outcome and biological indices was evaluated. OKG administration significantly improved nitrogen balance and reduced 3-methylhistidine and hydroxyproline urinary elimination. This was associated with a gradual rise in plasma glutamine over time. Given as a bolus, OKG significantly improved wound healing, assessed both clinically [day of last graft: (mean ± SEM) OKG bolus 23.7 ± 2.1 d versus Protil-1, 39.9 ± 9.9 d; P < 0.05] and by hydroxyproline excretion, and biological markers of nitrogen metabolism, and tended to reduce duration of enteral nutrition (P = 0.12). The higher catabolic status in the patients administered 20 g OKG/d at the onset of the study, despite randomization, precludes any definite conclusion (concerning the dose-effect relationship). However, based on 3-methylhistidine elimination, our data indicate a benefit of 30 g OKG/d administration over 10 g/d. This study further supports OKG supplementation in burn patients. In addition, this is the first trial based on objective data that favors bolus over continuous infusion of OKG in critically ill patients.

The Journal of Nutrition Vol. 128 No. 3 March 1998, pp. 563-569
Copyright ©1998 by the American Society for Nutritional Sciences

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