[Impact of intensive insulin therapy on surgical critically ill patients]

Wei He, Tong-Yan Zhang, Hua Zhou, Tong Li, Jing-Yang Zhao, Dong Zhao, Xu-Hai Liu, Jing Hou, Chao Wang, Yuan Xu
Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery] 2007 August 1, 45 (15): 1052-4

OBJECTIVE: To evaluating the effect of different levels of blood glucose control on inflammatory response and prognosis of the patients in surgical intensive care unit (SICU).

METHODS: One hundred and eighty-eight patients admitted to SICU were randomly divided into three groups, blood glucose were controlled by insulin infusion. Group A (75 cases): the mean blood glucose (MBG) was maintained at the level of 4.4 - 6.1 mmol/L. Group B (75 cases): MBG was maintained at the level of 6.7 - 8.3 mmol/L. Group C (38 cases): MBG was maintained at the level of 10.0 - 11.1 mmol/L. Blood glucose control was achieved with an effected computerized protocol. The outcome was evaluated by days in ICU, days to wean mechanical ventilation, infection, amount of red blood cell transfusion, hospital mortality and ICU cost.

RESULTS: Compared with other groups, hypoglycemia (< 3.3 mmol/L) in Group A was significantly increased (P < 0.05). Compared with Group C, red blood cell transfusion and infection were significantly reduced in Group A and Group B (P < 0.05). Compared with Group C, days of mechanical ventilation and days in ICU in Group A were significantly reduced (P < 0.05). Hospital mortality and ICU cost were reduced in Group A compared with the other groups (P > 0.05).

CONCLUSIONS: To maintain blood glucose in normal range with intensive insulin therapy has potential positive impact on SICU patients' outcome and can reduce days in ICU and ICU cost. Further correlation research is needed to determine the best levels of blood glucose in ICU patients.

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