Failure to achieve glycemic control despite intensive insulin therapy in a medical ICU: incidence and influence on ICU mortality.
OBJECTIVE
Intensive insulin therapy reduces mortality in subgroups of intensive care unit (ICU) patients, and awareness of the importance of blood glucose level (BGL) control has increased among ICU physicians and nurses. The impact of insulin treatment strategies on mortality may be influenced by their efficacy in achieving the target BGL range. We assessed the efficacy of an insulin treatment strategy in maintaining BGL within the target range, and we compared ICU mortality in patients who did and did not reach the BGL target.


METHODS
Prospective cohort study.


METHODS
12-bed medical ICU in a tertiary teaching hospital.


METHODS
Adults consecutively admitted over a 9-month period to an ICU where standard care included an insulin treatment strategy aimed at maintaining BGL<or=7 mmol/l.


RESULTS
105 patients were included. Median SAPS II was 45 (31-54). Failure to control BGL (mean capillary BGL >7 mmol/l after initial hyperglycemia correction) occurred in 32 patients (31.1%) and was associated with a significant increase in ICU mortality (56.2 vs. 23.3% in patients with successful BGL control). In the multivariate analysis, failure to control BGL independently predicted death in the ICU (OR 5.9, 2.1-16.6, p<0.001).


CONCLUSIONS
Failure to control BGL despite intensive insulin therapy was common and independently associated with ICU mortality. Failure to control BGL may considerably affect the overall impact of insulin treatment strategies on mortality.
Lacherade
Jean-Claude
JC
Service de Réanimation Médico-chirurgicale, Centre Hospitalier de Poissy-St-Germain, 10 rue du Champ Gaillard, 78300, Poissy, France. jclacherade@chi-poissy-st-germain.fr.
Jabre
Patricia
P
Hôpital Henri-Mondor AP-HP, 51 avenue du Maréchal de Tassigny, 94000, Créteil, France.|Faculté de Médecine de Bobigny, EA 3409, Université Paris XIII, 74 rue Marcel Cachin, 93000, Bobigny, France.
Bastuji-Garin
Sylvie
S
Hôpital Henri-Mondor AP-HP, 51 avenue du Maréchal de Tassigny, 94000, Créteil, France.
Grimaldi
David
D
Service de Réanimation Médico-chirurgicale, Centre Hospitalier de Poissy-St-Germain, 10 rue du Champ Gaillard, 78300, Poissy, France.
Fangio
Pascal
P
Service de Réanimation Médico-chirurgicale, Centre Hospitalier de Poissy-St-Germain, 10 rue du Champ Gaillard, 78300, Poissy, France.
Théron
Valerie
V
Service de Réanimation Médico-chirurgicale, Centre Hospitalier de Poissy-St-Germain, 10 rue du Champ Gaillard, 78300, Poissy, France.
Outin
Hervé
H
Service de Réanimation Médico-chirurgicale, Centre Hospitalier de Poissy-St-Germain, 10 rue du Champ Gaillard, 78300, Poissy, France.
De Jonghe
Bernard
B
Service de Réanimation Médico-chirurgicale, Centre Hospitalier de Poissy-St-Germain, 10 rue du Champ Gaillard, 78300, Poissy, France.
D000368:Aged; D001786:Blood Glucose / Q000187:drug effects*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017211:Treatment Failure
D001786:Blood Glucose; D007328:Insulin