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

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Abstract

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.

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