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Van den Berghe et al

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Intensive insulin therapy in critically ill patients. N Engl J Med 2001; 345:1359-67

  • single centre randomized controlled trial in a surgical ICU
  • adult patients requiring mechanical ventilation (63% were cardiac surgical patients)
  • randomized to target blood glucose of 4.4-6.1 or 10-11.1.
  • all patients received 10% glucose infusion
  • insulin infusion titrated to control blood sugar
  • severity of illness measured using APACHE II
  • 1548 patients recruited (study stopped following interim analysis)
  • 42% reduction in mortality in group with tight blood sugar control (4.6% vs 8%). This risk reduction occurred predominantly in those spending more than 5 days in ICU (10.6% vs 20.2% mortality)
  • morbidity also reduced
  • hypoglycaemia was more common in group with tight blood sugar control (~5% vs 0.7%)

Limitations

  • single centre
  • not possible to truly blind the study due to physicians' awareness of blood glucose results
  • high mortality amongst cardiac surgical patients in control group (5.1%)
  • not possible to distinguish between beneficial effects of insulin and beneficial effects of tight blood sugar control
 

©Charles Gomersall, October, 2009 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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