[Impact of intensive insulin therapy on surgical critically ill patients].
OBJECTIVE
To evaluating the effect of different levels of blood glucose control on inflammatory response and prognosis of the patients in surgical intensive care unit (SICU).


METHODS
One hundred and eighty-eight patients admitted to SICU were randomly divided into three groups, blood glucose were controlled by insulin infusion. Group A (75 cases): the mean blood glucose (MBG) was maintained at the level of 4.4 - 6.1 mmol/L. Group B (75 cases): MBG was maintained at the level of 6.7 - 8.3 mmol/L. Group C (38 cases): MBG was maintained at the level of 10.0 - 11.1 mmol/L. Blood glucose control was achieved with an effected computerized protocol. The outcome was evaluated by days in ICU, days to wean mechanical ventilation, infection, amount of red blood cell transfusion, hospital mortality and ICU cost.


RESULTS
Compared with other groups, hypoglycemia (< 3.3 mmol/L) in Group A was significantly increased (P < 0.05). Compared with Group C, red blood cell transfusion and infection were significantly reduced in Group A and Group B (P < 0.05). Compared with Group C, days of mechanical ventilation and days in ICU in Group A were significantly reduced (P < 0.05). Hospital mortality and ICU cost were reduced in Group A compared with the other groups (P > 0.05).


CONCLUSIONS
To maintain blood glucose in normal range with intensive insulin therapy has potential positive impact on SICU patients' outcome and can reduce days in ICU and ICU cost. Further correlation research is needed to determine the best levels of blood glucose in ICU patients.
He
Wei
W
Surgical Intensive Care Unit, Beijing Tong Ren Hospital, Capital Medical University, Beijing 100730, China. icuhe@163.com
Zhang
Tong-Yan
TY
Zhou
Hua
H
Li
Tong
T
Zhao
Jing-Yang
JY
Zhao
Dong
D
Liu
Xu-Hai
XH
Hou
Jing
J
Wang
Chao
C
Xu
Yuan
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D016638:Critical Illness; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007249:Inflammation / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D011379:Prognosis; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin