Intensive Insulin Therapy in Critically Ill Patients Export

@article{citeulike:489762, abstract = {Background Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes. Whether the normalization of blood glucose levels with insulin therapy improves the prognosis for such patients is not known. Methods We performed a prospective, randomized, controlled study involving adults admitted to our surgical intensive care unit who were receiving mechanical ventilation. On admission, patients were randomly assigned to receive intensive insulin therapy (maintenance of blood glucose at a level between 80 and 110 mg per deciliter) or conventional treatment (infusion of insulin only if the blood glucose level exceeded 215 mg per deciliter and maintenance of glucose at a level between 180 and 200 mg per deciliter). Results At 12 months, with a total of 1548 patients enrolled, intensive insulin therapy reduced mortality during intensive care from 8.0 percent with conventional treatment to 4.6 percent (P<0.04, with adjustment for sequential analyses). The benefit of intensive insulin therapy was attributable to its effect on mortality among patients who remained in the intensive care unit for more than five days (20.2 percent with conventional treatment, as compared with 10.6 percent with intensive insulin therapy; P=0.005). The greatest reduction in mortality involved deaths due to multiple-organ failure with a proven septic focus. Intensive insulin therapy also reduced overall in-hospital mortality by 34 percent, bloodstream infections by 46 percent, acute renal failure requiring dialysis or hemofiltration by 41 percent, the median number of red-cell transfusions by 50 percent, and critical-illness polyneuropathy by 44 percent, and patients receiving intensive therapy were less likely to require prolonged mechanical ventilation and intensive care. Conclusions Intensive insulin therapy to maintain blood glucose at or below 110 mg per deciliter reduces morbidity and mortality among critically ill patients in the surgical intensive care unit. 10.1056/NEJMoa011300}, address = {Department of Intensive Care Medicine, Catholic University of Leuven, Belgium. greta.vandenberghe@med.kuleuven.ac.be}, author = {Van den Berghe, Greet and Wouters, Pieter and Weekers, Frank and Verwaest, Charles and Bruyninckx, Frans and Schetz, Miet and Vlasselaers, Dirk and Ferdinande, Patrick and Lauwers, Peter and Bouillon, Roger}, citeulike-article-id = {489762}, citeulike-linkout-0 = {http://dx.doi.org/10.1056/NEJMoa011300}, citeulike-linkout-1 = {http://content.nejm.org/content/345/19/1359.abstract}, citeulike-linkout-2 = {http://content.nejm.org/content/345/19/1359.full.pdf}, citeulike-linkout-3 = {http://content.nejm.org/cgi/content/abstract/345/19/1359}, citeulike-linkout-4 = {http://view.ncbi.nlm.nih.gov/pubmed/11794168}, citeulike-linkout-5 = {http://www.hubmed.org/display.cgi?uids=11794168}, day = {8}, doi = {10.1056/NEJMoa011300}, issn = {0028-4793}, journal = {N Engl J Med}, keywords = {insuline, reanimation, soins\_intensifs}, month = {November}, number = {19}, pages = {1359--1367}, posted-at = {2008-03-15 16:37:12}, priority = {2}, title = {Intensive Insulin Therapy in Critically Ill Patients}, url = {http://dx.doi.org/10.1056/NEJMoa011300}, volume = {345}, year = {2001} }

TY - JOUR ID - citeulike:489762 L3 - citeulike-article-id:489762 N2 - Background Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes. Whether the normalization of blood glucose levels with insulin therapy improves the prognosis for such patients is not known. Methods We performed a prospective, randomized, controlled study involving adults admitted to our surgical intensive care unit who were receiving mechanical ventilation. On admission, patients were randomly assigned to receive intensive insulin therapy (maintenance of blood glucose at a level between 80 and 110 mg per deciliter) or conventional treatment (infusion of insulin only if the blood glucose level exceeded 215 mg per deciliter and maintenance of glucose at a level between 180 and 200 mg per deciliter). Results At 12 months, with a total of 1548 patients enrolled, intensive insulin therapy reduced mortality during intensive care from 8.0 percent with conventional treatment to 4.6 percent (P<0.04, with adjustment for sequential analyses). The benefit of intensive insulin therapy was attributable to its effect on mortality among patients who remained in the intensive care unit for more than five days (20.2 percent with conventional treatment, as compared with 10.6 percent with intensive insulin therapy; P=0.005). The greatest reduction in mortality involved deaths due to multiple-organ failure with a proven septic focus. Intensive insulin therapy also reduced overall in-hospital mortality by 34 percent, bloodstream infections by 46 percent, acute renal failure requiring dialysis or hemofiltration by 41 percent, the median number of red-cell transfusions by 50 percent, and critical-illness polyneuropathy by 44 percent, and patients receiving intensive therapy were less likely to require prolonged mechanical ventilation and intensive care. Conclusions Intensive insulin therapy to maintain blood glucose at or below 110 mg per deciliter reduces morbidity and mortality among critically ill patients in the surgical intensive care unit. 10.1056/NEJMoa011300 IS - 19 JF - N Engl J Med SN - 0028-4793 AD - Department of Intensive Care Medicine, Catholic University of Leuven, Belgium. greta.vandenberghe@med.kuleuven.ac.be EP - 1367 TI - Intensive Insulin Therapy in Critically Ill Patients VL - 345 SP - 1359 KW - insuline KW - reanimation KW - soins_intensifs AU - Van den Berghe, Greet AU - Wouters, Pieter AU - Weekers, Frank AU - Verwaest, Charles AU - Bruyninckx, Frans AU - Schetz, Miet AU - Vlasselaers, Dirk AU - Ferdinande, Patrick AU - Lauwers, Peter AU - Bouillon, Roger PY - 2001/11/08/ UR - http://dx.doi.org/10.1056/NEJMoa011300 ER -