Intensive insulin therapy confers a similar survival benefit in the burn intensive care unit to the surgical intensive care unit

B Robert Gibson, Panagis Galiatsatos, Atoosa Rabiee, Lisa Eaton, Rania Abu-Hamdah, Colleen Christmas, Stephen M Milner, Dana K Andersen, Dariush Elahi
Surgery 2009, 146 (5): 922-30

BACKGROUND: In contrast to the benefits of intensive insulin therapy (IIT) in the surgical intensive care unit (SICU), its benefits in the burn ICU (BICU) remain unclear. Furthermore, IIT and tight glycemic control has received little attention in elderly ICU patients.

METHODS: We evaluated the normalization of blood glucose level with IIT in BICU and SICU patients. From October 2006 to July 2007, 970 patients were admitted to our BICU and our SICU. A total of 79 of these patients met criteria for initiation of IIT, 37 of who required IIT for at least 72 hours. Data were analyzed to determine if tight glycemic control (blood glucose < or =150 mg/dL by day 3) is associated with reduced morbidity and mortality.

RESULTS: Tight control was better achieved in SICU patients (45%) than in BICU patients (33%). Daily insulin requirements were approximately 2-fold greater in SICU patients compared with BICU patients (P < .05). Tight control in both SICU and BICU patients was associated with a decreased incidence of sepsis compared with poor glycemic control (10% vs 58% and 60% vs 70%, respectively) and a decreased mortality rate (0 vs 58% and 20% vs 50%; SICU vs BICU, respectively). The percentage of total body surface area burned in BICU patients was 10% and 45% in the < or =150 and >150 mg/dL groups. Mortality rate in the poor control group was >10-fold greater than that of the tight control group; for patients > or =65 years of age, mortality was nearly double than that of patients <65 years of age. The greatest mortality rate (62%) was seen in patients >65 years of age with poor control.

CONCLUSION: Tight control with IIT is associated with an increased survival rate in both BICU and SICU patients. Age is associated with survival, with patients older than 65 years of age having the greatest mortality rate.

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