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Intensive insulin therapy to non-cardiac ICU patients: a prospective study

Published online by Cambridge University Press:  04 April 2006

P. Toft ,
H. S. Jørgensen ,
E. Toennesen  and
C. Christiansen
P. Toft
Affiliation:
Aarhus University Hospital, Department of Anaesthesiology and Intensive Care, Aarhus, Denmark Odense University Hospital, Department of Anaesthesiology and Intensive Care, Odense, Denmark
H. S. Jørgensen
Affiliation:
Aarhus University Hospital, Department of Anaesthesiology and Intensive Care, Aarhus, Denmark
E. Toennesen
Affiliation:
Aarhus University Hospital, Department of Anaesthesiology and Intensive Care, Aarhus, Denmark
C. Christiansen
Affiliation:
Aarhus University Hospital, Department of Anaesthesiology and Intensive Care, Aarhus, Denmark
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Summary

Objective: Intensive insulin therapy reduced mortality in patients admitted to an intensive care unit following mainly cardiac surgery. The aim of this prospective study was to evaluate, if intensive insulin therapy could reduce mortality in medical and non-cardiac surgical patients admitted to a multidisciplinary intensive care unit. Patients and methods: For 6 months all adult patients, admitted to the intensive care unit, were included. Insulin was administered, if blood glucose 12 mmol L−1. For the next 6 months blood glucose level was reduced with intensive insulin therapy (aim 4.4 < BG < 6.1 mmol L−1); 271 patients were included. Patient characteristics data, APACHE II score, morbidity and mortality were recorded. Results: At admission the two groups were comparable. The overall relative mortality was reduced 20% in the intensive insulin treated group (n.s.). In the intensive insulin treated group mortality was 13.1% in the medical patients and 11.2% in the surgical patients compared to 15.8% and 14.4%, respectively, in the conventional treated group (n.s.). The frequency of secondary infections was 21.5% in the intensive insulin treated group and 16.0% in the conventional treated group (n.s.). The proportion of hypoglycaemia increased from 4% to 14% (P < 0.05). Conclusions: Following intensive insulin therapy there was a trend towards reduced mortality in medical and non-cardiac surgical patients but less pronounced as in cardiac surgical patients. Intensive insulin therapy increased the frequency of hypoglycaemia. Around 4400 patients would have to be included in any future randomized study to reach significance.

Keywords

CRITICAL CAREINSULINHYPOGLYCAEMIAMORTALITY
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 8 , August 2006 , pp. 705 - 709
Copyright
© 2006 European Society of Anaesthesiology

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References

Mizock BA. Alterations in fuel metabolism in critical illness: hyperglycaemia. Best Pract Res Clin Endocrinol Metab 2001; 15: 533–551.Google Scholar
Thomas MC, Mathew TH, Russ GR, Rao MM, Moran J. Early peri-operative glycaemic control and allograft rejection in patients with diabetes mellitus: a pilot study. Transplantation 2001; 72: 1321–1324.Google Scholar
Furnary P, Gao G, Grunkemeier GL et al. Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. Thorac Cardiovasc Surg 2003; 125: 1007–1019.Google Scholar
Scheen AJ, Radermecker RP, Philips JC. Effect of intensive insulin therapy after an acuta myocardial infarction in patients with type 2 diabetes: results of the DIGAMI-2 trial. Rev Med Liege 2004; 59: 534–539.Google Scholar
Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycaemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 2002; 87: 978–982.Google Scholar
Weir CJ, Murray GD, Dyker AG, Lees KR. Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long-term follow up study. BMJ 1997; 314: 1303–1306.Google Scholar
Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet 2000; 355: 773–778.Google Scholar
Finney SJ, Zekveld C, Elia A, Evans TW. Glucose control and mortality in critically ill patients. JAMA 2003; 290: 2041–2047.Google Scholar
Fath-Ordoubadi F, Beatt KJ. Glucose–insulin–potassium therapy for the treatment of acute myocardial infarction. Circulation 1997; 96: 1152–1156.Google Scholar
Van den Berghe G, Wouters PJ, Bouillon R et al. Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med 2003; 31: 359–366.Google Scholar
Van den Berghe G, Wouters PJ, Weekers F et al. Intensive insulin therapy in the critically ill patients. New Engl J Med 2001; 345: 1359–1367.Google Scholar
Gore DC, Chinkes D, Heggers J, Herndon DN, Wolf SE, Desai M. Association of hyperglycaemia with increased mortality after severe burn injury. J Trauma 2001; 51: 540–544.Google Scholar
Furnary AP, Zerr KJ, Grunkemeier GL, Star A. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg 1999; 67: 352–360.Google Scholar
Perner A, Nielsen SE, Rask-Madsen J. High glucose impairs superoxide production from isolated blood neutrophils. Intensive Care Med 2003; 29: 642–645.Google Scholar
Saeed FA, Castle GE. Neutrophil chemiluminescence during phagocytosis is inhibited by abnormally elevated levels of acetoacetate: implications for diabetic susceptibility to infections. Clin Diagn Lab Immunol 1998; 5: 740–743.Google Scholar
Kanji S, Singh A, Tierney M, Meggison H, McIntyre L, Hebert PC. Standardization of intravenous insulin therapy improves the efficiency and safety of blood glucose control in critically ill adults. Intensive Care Med 2004; 30: 804–810.Google Scholar
Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc 2004; 79: 992–1000.Google Scholar