Full title: A RandomizEd Trial of ENtERal Glutamine to minimIZE Thermal Injury (multicentre pragmatic RTC)

Aim: to recruit 2700 patients worldwide to a large multicentre RTC to determine the efficacy and safety of glutamine supplementation for reducing infectious morbidity and mortality in severe burns patients.

Background: Worldwide burns are ranked the fourth most common injury, mostly affecting young to middle-aged people. In low and middle income countries burns are the leading cause of disability adjusted life years, indicating a significant public health burden. While mortality from burns injuries has plateaued, the leading cause of death continues to be sepsis and multi organ failure with burns patients demonstrating a 3-fold higher prevalence of sepsis than other trauma patients, and a much higher rate of mortality from sepsis than other critically ill patients. Therefore, optimising prevention and treatment of sepsis in burns patients is vital.

The inflammation and catabolism associated with severe burns exacerbates nutrient deficiencies that predispose patients to reduced immune function, increasing the risk of infective complications, organ dysfunction and death. In observational studies levels of the amino acid glutamine has been shown to fall acutely during critical illness which has been associated with immune dysfunction and increased mortality. However, while there are some small trials of glutamine supplementation in burns patients showing positive reduction in infective morbidity and mortality, other trials in critically ill patients with multi organ failure suggest glutamine may be harmful.