• Nicholas Heming, Robert Carlier, Helene Prigent, Ahmed Mekki, Camille Jousset, Frederic Lofaso, Xavier Ambrosi, Rania Bounab, Virginie Maxime, Arnaud Mansart, Pascal Crenn, Pierre Moine, Fabien Foltzer, Bernard Cuenoud, Tobias Konz, John Corthesy, Maurice Beaumont, Mickaël Hartweg, Claudia Roessle, Jean-Charles Preiser, Denis Breuillé, and Djillali Annane.
• General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines, University Paris Saclay, 104, Boulevard Raymond Poincaré, 92380, Garches, France.
• Crit Care. 2022 Nov 17; 26 (1): 358358.

BackgroundA defining feature of prolonged critical illness is muscle wasting, leading to impaired recovery. Supplementation with a tailored blend of amino acids may bolster the innate gut defence, promote intestinal mucosa repair and limit muscle loss.MethodsThis was a monocentric, randomized, double-blind, placebo-controlled study that included patients with sepsis or acute respiratory distress syndrome. Patients received a specific combination of five amino acids or placebo mixed with enteral feeding for 21 days. Markers of renal function, gut barrier structure and functionality were collected at baseline and 1, 2, 3 and 8 weeks after randomization. Muscle structure and function were assessed through MRI measurements of the anterior quadriceps volume and by twitch airway pressure. Data were compared between groups relative to the baseline.ResultsThirty-five critically ill patients were randomized. The amino acid blend did not impair urine output, blood creatinine levels or creatinine clearance. Plasma citrulline levels increased significantly along the treatment period in the amino acid group (difference in means [95% CI] 5.86 [1.72; 10.00] nmol/mL P = 0.007). Alanine aminotransferase and alkaline phosphatase concentrations were lower in the amino acid group than in the placebo group at one week (ratio of means 0.5 [0.29; 0.86] (P = 0.015) and 0.73 [0.57; 0.94] (P = 0.015), respectively). Twitch airway pressure and volume of the anterior quadriceps were greater in the amino acid group than in the placebo group 3 weeks after randomization (difference in means 10.6 [0.99; 20.20] cmH20 (P = 0.035) and 3.12 [0.5; 5.73] cm3/kg (P = 0.022), respectively).ConclusionsAmino acid supplementation increased plasma citrulline levels, reduced alanine aminotransferase and alkaline phosphatase levels, and improved twitch airway pressure and anterior quadriceps volume. Trial registration ClinicalTrials.gov, NCT02968836. Registered November 21, 2016.© 2022. The Author(s).

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