Impact of intensive insulin therapy on neuromuscular complications and ventilator dependency in the medical intensive care unit.
BACKGROUND
Critical illness polyneuropathy/myopathy causes limb and respiratory muscle weakness, prolongs mechanical ventilation, and extends hospitalization of intensive care patients. Besides controlling risk factors, no specific prevention or treatment exists. Recently, intensive insulin therapy prevented critical illness polyneuropathy in a surgical intensive care unit.


OBJECTIVE
To investigate the impact of intensive insulin therapy on polyneuropathy/myopathy and treatment with prolonged mechanical ventilation in medical patients in the intensive care unit for at least 7 days.


METHODS
This was a prospectively planned subanalysis of a randomized controlled trial evaluating the effect of intensive insulin versus conventional therapy on morbidity and mortality in critically ill medical patients. All patients who were still in intensive care on Day 7 were screened weekly by electroneuromyography. The effect of intensive insulin therapy on critical illness polyneuropathy/myopathy and the relationship with duration of mechanical ventilation were assessed.


RESULTS
Independent of risk factors, intensive insulin therapy reduced incidence of critical illness polyneuropathy/myopathy (107/212 [50.5%] to 81/208 [38.9%], p = 0.02). Treatment with prolonged (> or = 14 d) mechanical ventilation was reduced from 99 of 212 (46.7%) to 72 of 208 (34.6%) (p = 0.01). This was statistically only partially explained by prevention of critical illness polyneuropathy/myopathy.


CONCLUSIONS
In a subset of medical patients in the intensive care unit for at least 7 days, enrolled in a randomized controlled trial of intensive insulin therapy, those assigned to intensive insulin therapy had a reduced incidence of critical illness polyneuropathy/myopathy and were treated with prolonged mechanical ventilation less frequently.
Hermans
Greet
G
Medical Intensive Care Unit, Department of Internal Medicine, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
Wilmer
Alexander
A
Meersseman
Wouter
W
Milants
Ilse
I
Wouters
Pieter J
PJ
Bobbaers
Herman
H
Bruyninckx
Frans
F
Van den Berghe
Greet
G
D001786:Blood Glucose; D003422:Critical Care; D016638:Critical Illness; D004305:Dose-Response Relationship, Drug; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012132:Respiratory Muscles / Q000187:drug effects / Q000503:physiopathology; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin