Intensive Insulin Therapy in Critically Ill Patients
Greet Van den Berghe, M.D., Ph.D., Pieter Wouters, M.Sc., Frank Weekers, M.D., Charles Verwaest, M.D., Frans Bruyninckx, M.D., Miet Schetz, M.D., Ph.D., Dirk Vlasselaers, M.D., Patrick Ferdinande, M.D., Ph.D., Peter Lauwers, M.D., and Roger Bouillon, M.D., Ph.D.
Background Hyperglycemia and insulin resistance are common incritically ill patients, even if they have not previously haddiabetes. Whether the normalization of blood glucose levelswith insulin therapy improves the prognosis for such patientsis not known.
Methods We performed a prospective, randomized, controlled studyinvolving adults admitted to our surgical intensive care unitwho were receiving mechanical ventilation. On admission, patientswere randomly assigned to receive intensive insulin therapy(maintenance of blood glucose at a level between 80 and 110mg per deciliter) or conventional treatment (infusion of insulinonly if the blood glucose level exceeded 215 mg per deciliterand maintenance of glucose at a level between 180 and 200 mgper deciliter).
Results At 12 months, with a total of 1548 patients enrolled,intensive insulin therapy reduced mortality during intensivecare from 8.0 percent with conventional treatment to 4.6 percent(P<0.04, with adjustment for sequential analyses). The benefitof intensive insulin therapy was attributable to its effecton mortality among patients who remained in the intensive careunit for more than five days (20.2 percent with conventionaltreatment, as compared with 10.6 percent with intensive insulintherapy; P=0.005). The greatest reduction in mortality involveddeaths due to multiple-organ failure with a proven septic focus.Intensive insulin therapy also reduced overall in-hospital mortalityby 34 percent, bloodstream infections by 46 percent, acute renalfailure requiring dialysis or hemofiltration by 41 percent,the median number of red-cell transfusions by 50 percent, andcritical-illness polyneuropathy by 44 percent, and patientsreceiving intensive therapy were less likely to require prolongedmechanical ventilation and intensive care.
Conclusions Intensive insulin therapy to maintain blood glucoseat or below 110 mg per deciliter reduces morbidity and mortalityamong critically ill patients in the surgical intensive careunit.
Source Information
From the Department of Intensive Care Medicine (G.V.B., P.W., F.W., C.V., M.S., D.V., P.F., P.L.), the Electromyography Laboratory, Department of Physical Medicine and Rehabilitation (F.B.), and the Laboratory for Experimental Medicine and Endocrinology (R.B.), Catholic University of Leuven, Leuven, Belgium.
Address reprint requests to Dr. Van den Berghe at the Department of Intensive Care Medicine, University Hospital Gasthuisberg, University of Leuven, B-3000 Leuven, Belgium, or at greta.vandenberghe{at}med.kuleuven.ac.be.
Intensive Insulin Therapy in Critically Ill Patients
Hirsch I. B., Coviello A., Mazuski J. E., Bailey J. A., Shapiro M. J., McCowen K. C., Maykel J. A., Bistrian B. R., Nusbaum N. J., van den Berghe G., Bouillon R., Lauwers P.
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N Engl J Med 2002;
346:1586-1588, May 16, 2002.
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