A RANDOMIZED CONTROLLED TRIAL OF THE INFLUENCE OF THE MODE OF ENTERALORNITHINE ALPHA-KETOGLUTARATE ADMINISTRATION IN BURN PATIENTS

To investigate appropriate mode and daily dose of enteral ornithine al pha-ketoglutarate (OKG) administration, 54 burn patients (total burn s urface area: 20-50%) were included in a randomized controlled trial an d 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 isonitro genous 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 administrat ion significantly improved nitrogen balance and reduced 3-methylhistid ine and hydroxyproline urinary elimination. This was associated with a gradual rise in plasma glutamine over time. Given as a bolus, OKG sig nificantly improved wound healing, assessed both clinically [day of la st 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 ente ral nutrition (P = 0.12). The higher catabolic status in the patients administered 20 g OKG/d at the onset of the study, despite randomizati on, precludes any definite conclusion (concerning the dose-effect rela tionship). However, based on 3-methylhistidine elimination, our data i ndicate a benefit of 30 g OKG/d administration over 10 g/d. This study further supports OKG supplementation in burn patients. In addition, t his is the first trial based on objective data that favors bolus over continuous infusion of OKG in critically ill patients.