Please select the eligibility criteria that correspond to the clinical trial below.
Title: N/A
Brief Summary: Glutamine is the most abundant nonessential amino acid in the human body. Besides its role as a constituent of proteins and its importance in amino acid transamination, glutamine may modulate immune cells.

The innate immune system is the first line of host defence against pathogens and in most cases sufficient to eliminate invading microbes. Mammalian Toll-like receptors (TLR) comprise a family of germ line-encoded trans-membrane receptors which activation leads to the induction of inflammatory responses, phagocytosis but also to the development of antigen specific adapative immunity.

It has been postulated though not formally proven yet that glutamine beneficial effect could be due to a positive effect on the innate immune system. Given the importance of TLRs and TLRs-dependent signalling in host defence against infections we hypothesized that glutamine may increase the expression and/or functionality of TLRs which in turn may have beneficial effects to clear infections.


Options:
A: Inclusion Criteria:

1. Deep 2nd and/or 3rd degree burns requiring grafting
2. Patient meets one of the following 4 criteria:

   1. Patients 18 - 39 years of age with ≥ 20% TBSA\* burn
   2. Patients 18 - 39 years of age with ≥ 15% TBSA\* burn and with inhalation injury
   3. Patients 40 - 59 years of age with ≥ 15% TBSA\* burn
   4. Patients ≥ 60 years of age ≥ 10% TBSA\* \*TBSA - Total Body Surface Area

Exclusion Criteria:

1. \> 72 hrs from admission to ICU to time of consent.
2. Patients younger than 18 years of age.
3. a) Patients without known renal disease and renal dysfunction defined as a serum creatinine \>171 µmol/L or a urine output of less than 500 mL/last 24 hours (or 80 mL/last 4 hours if a 24 hour period of observation is not available).

   b) Patients with acute on chronic renal failure (pre-dialysis) with an absolute increase of \>80 µmol/L from baseline or pre-admission creatinine or a urine output of \<500 mL/last 24 hours (or 80 mL/last 4 hours).

   c) Patients with chronic renal failure on dialysis will be excluded.
4. Liver cirrhosis - Child-Pugh class C liver disease
5. Pregnant or lactating females.
6. Contra-indication for EN: intestinal occlusion or perforation, intra-abdominal injury.
7. Patients with injuries from high voltage electrical contact.
8. Patients who are moribund (not expected to survive the next 72 hours).
9. Patients with extreme body sizes: BMI \< 18 or \> 50
10. Enrollment in another industry sponsored ICU intervention study.
11. Received glutamine supplement for \> 24 hrs prior to randomization
12. Known allergy to maltodextrin, corn starch, corn, corn products or glutamine.
B: Inclusion Criteria:

* Mechanically ventilated patients \> or = 18 years old
* 2 or more organ failures related to acute illness

Exclusion Criteria:

* \> 24 hours from admission to ICU
* Patients who are moribund
* Lack of commitment to aggressive care
* Absolute contraindication to enteral nutrients
* Severe acquired brain injury
* Routine elective cardiac surgery
* Primary admission of burns \> 30% body surface area
* Weight \< 50 kgms or \> 200 kgms
* Pregnant or lactating patients
* Previous randomization in this study
* Enrollment in a related ICU interventional study
* Child's class C liver disease
* Metastatic cancer with life expectancy \< 6 months
* Seizure disorder requiring anticonvulsant medication
C: Inclusion Criteria:

* Age between 18 and 75 years (inclusive).
* Moderate to severe trauma, as defined by an Injury Severity Score (ISS) \> 12 points were included in the study
* Traumatic patients who required total parenteral nutrition

Exclusion Criteria:

* Patients who were under 17 and over 76 years of age,
* Patients whose life expectancy was less than 5 days
* Patientes allergic to glutamine.
* Patients with any basic pathology included any serious immune system condition (diabetes, HIV, lupus, etc.) or who, in their long-term treatment prior to admission to ICU, received corticoids or any other immunosuppressant medication.
* Pregnant women.
D: Inclusion Criteria:

* Age 18-58 years
* Patients admitted with a diagnosis of multiple trauma requiring enteral feeding for \> 48 hours
* Expected length of stay in ICU \> 48 hours
* Has a functional access for enteral tube feeding and a central access for administration of test solution
* Negative Beta HCG (pregnancy test) in females (18-60 years)

Exclusion Criteria:

* Age \< 18 years
* Significant hepatic failure (Patients with Childs C Cirrhosis)
* Severe renal failure (estimated glomerular filtration rate \[eGFR\] \< 50 ml/min)
* Patients with severe metabolic acidosis (pH \<7.35)
* Not expected to be in the ICU \> 48 hours (due to imminent death)
* Unable to tolerate enteral nutrition within 72 hours
* Enrolment in other ICU intervention study if contraindicated
* Patients in whom parenteral nutrition is required from the outset
* Absolute contraindication to enteral nutrition

Answer: C