Glycaemic control and perioperative organ protection.
The concept of stress hyperglycaemia as an adaptive, beneficial response in critical illness has recently been challenged. Two large prospective randomized controlled trials in the Leuven University Hospital surgical and medical ICUs demonstrated that maintenance of normoglycaemia with intensive insulin therapy substantially prevents morbidity and reduces mortality. Strict normoglycaemia is required to gain most clinical benefit. With this therapy the risk of hypoglycaemia increased, but without inducing obvious clinical sequellae. Other studies have been used to advocate against implementation of intensive insulin therapy by showing lack of benefit or questioning safety. However, these studies are inconclusive on this subject, due to problems of not reaching normal glucose levels clearly separated from the standard glycaemic group or lack of statistical power. Clearly, future studies should be adequately powered and comply with the study protocol in order to confirm the survival and other clinical benefits of intensive insulin therapy.
Berkers
Joost
J
Department of Intensive Care Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium.
Gunst
Jan
J
Vanhorebeek
Ilse
I
Van den Berghe
Greet
G
D003422:Critical Care / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007362:Intensive Care Units; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D007902:Length of Stay; D015337:Multicenter Studies as Topic; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic
D007004:Hypoglycemic Agents; D007328:Insulin