Euglycemic hyperinsulinemia in severe sepsis and septic shock.
BACKGROUND
Recent studies have suggested that strict glucose control with intensive insulin therapy in critically ill patients may result in better outcomes. Whether this is also true in septic shock has not been determined. In addition, whether it is the insulin administration per se or the glucose control that contributes to the beneficial effects is unclear. We raised the hypothesis that euglycemic hyperinsulinemia (EH) might improve the outcome from septic shock due to peritonitis.


METHODS
Fourteen anesthetized, mechanically ventilated, and hemodynamically monitored sheep received 1.5 g/kg body weight i.p. feces to induce sepsis. Ringer's lactate and 6% hydroxyethyl starch solutions were infused throughout the experiment to prevent hypovolemia. Two hours after feces injection, the animals were randomized to either an EH group (n = 7) receiving insulin 0.25 U/ kg/h, 20% glucose (to maintain blood glucose at 40-90 mg/dl), and potassium (to maintain the potassium level at 4.0- 5.5 mmol/l) or a control group (n = 7) with no intervention. All animals were studied until their spontaneous death or for 30 h.


RESULTS
The EH group received a greater volume of 20% glucose, but blood glucose and potassium concentrations were similar in the two groups. No significant differences were found in hemodynamic variables. The circulating interleukin-6 levels increased in both groups after feces injection, but tended to be lower in the EH group (p < 0.05). The survival times were similar in the two groups (median 20.0 h in the EH group vs. 17.0 h in the control group; p = 0.73).


CONCLUSIONS
In this clinically relevant sheep septic shock model, EH decreased blood interleukin-6 concentrations but did not change hemodynamics or improve the outcome.
Su
Fuhong
F
Department of Intensive Care, Erasme Hospital, Free University of Brussels, Brussels, Belgium.
Wang
Zhen
Z
Bruhn
Alejandro
A
Verdant
Colin
C
Cai
Ying
Y
Vincent
Jean-Louis
JL
D000818:Animals; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D005260:Female; D007328:Insulin / Q000097:blood / Q000627:therapeutic use*; D015850:Interleukin-6 / Q000097:blood; D018805:Sepsis / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D012756:Sheep; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology
D001786:Blood Glucose; D007328:Insulin; D015850:Interleukin-6