 |
More than 4,000 participants from medical sites around the world attended
this congress. In his opening remarks, host Professor J.L. Vincent recognised
how recent study results represent major strides in intensive and emergency
care medicine. He cited, for example, the finding that 'tight'
glycaemic control using intensive insulin therapy reduces mortality by
half in postoperative patients.
According to Dr. G. Van den Berghe (Belgium), “critically ill patients
who require intensive care for more than 5 days have a 20% risk for death.”
Among these patients, morbidities are frequent, and care is very costly.
Notably, the conditions of insulin resistance and hyperglycaemia seem
to predispose patients to complications—severe infections, polyneuropathy,
multiple organ failure, and death. Because hyperglycaemia occurs commonly
among critically ill patients, Dr. Van den Berghe and colleagues performed
a randomised, controlled trial to determine whether 'tight'
control of blood glucose levels by intensive insulin therapy could reduce
complications (NEJM. 2001;345:1359). The majority of patients in
the trial were recovering from cardiac surgery.
Patients (n = 1548) were assigned to receive either conventional treatment
(blood glucose maintained between 180 and 200 mg/dL) or intensive treatment
(blood glucose maintained between 80 and 110 mg/dL) by continuous infusion
of insulin, as needed. In the intensive-treatment group, nearly all patients
required exogenous insulin, while only 39% of the patients treated with
the conventional approach received insulin.
Among patients who remained in the ICU for more than 5 days, the mortality
rate was strikingly lowered to 10.6% by intensive insulin therapy, compared
to more than 20% among patients with conventional therapy. Furthermore,
intensive insulin therapy dramatically reduced bloodstream infections,
acute renal failure, and the need for red-cell transfusion or prolonged
mechanical ventilation. In addition to health benefits, costs for care
were likewise reduced more than 20% by 'tight' control of blood
glucose.
Dr. Van den Berghe concluded that intensive insulin therapy to maintain
blood glucose at or below 110 mg/dL can dramatically reduce morbidity
and mortality among critically ill patients in the surgical intensive
care unit.
Note: The study results described above were published in NEJM.
345:1359-1367 (Nov 2001).
|
|
