title: Intensive versus intermediate glucose control in surgical intensive care unit patients.
abstract: OBJECTIVE
  The optimal perioperative blood glucose range to improve surgical site infection (SSI) in surgical intensive care unit (ICU) patients remains unclear. We sought to determine whether the incidence of SSI is reduced by perioperative intensive insulin therapy (IT).
  
  
  METHODS
  Patients were randomly assigned to receive perioperative intensive IT, with a target blood glucose range of 4.4-6.1 mmol/L, or intermediate IT, with a target blood glucose range of 7.7-10.0 mmol/L in the surgical ICU. We defined the primary end point as the incidence of SSI.
  
  
  RESULTS
  Study participants were randomly assigned to glucose control with one of two target ranges: for 225 patients in the intermediate IT group or for 222 patients in the intensive IT group, respectively. No patients in either group became hypoglycemic (<4.4 mmol/L) during their stay in the surgical ICU. In our series, the rate of SSI after hepato-biliary-pancreatic surgery was 6.7%. Patients in the intensive IT group, compared with the intermediate IT group, had fewer postoperative SSIs (9.8% vs. 4.1%, P = 0.028) and a lower incidence of postoperative pancreatic fistula after pancreatic resection (P = 0.040). The length of hospitalization required for patients in the intensive IT group was significantly shorter than that in the intermediate IT group (P = 0.017).
  
  
  CONCLUSIONS
  We found that intensive IT decreased the incidence of SSI among patients who underwent hepato-biliary-pancreatic surgery: a blood glucose target of 4.4 to 6.1 mmol/L resulted in lower rate of SSI than did a target of 7.7-10.0 mmol/L.
authors.affiliation: Center for Innovative and Translational Medicine, Regenerative Medicine Group, Department of Surgery, Kochi Medical School, Kochi University, Kochi, JapanCenter for Innovative and Translational Medicine, Regenerative Medicine Group, Department of Surgery, Kochi Health Sciences Center, Kochi Medical School, Kochi University, Kochi, Japan tokabaya@kochi-u.ac.jp.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Okabayashi
authors.affiliation: Center for Innovative and Translational Medicine, Regenerative Medicine Group, Department of Surgery, Kochi Health Sciences Center, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Shima
authors.affiliation: Center for Innovative and Translational Medicine, Regenerative Medicine Group, Department of Surgery, Kochi Health Sciences Center, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Tatsuaki
authors.initials: T
authors.lastname: Sumiyoshi
authors.affiliation: Center for Innovative and Translational Medicine, Regenerative Medicine Group, Department of Surgery, Kochi Health Sciences Center, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Akihito
authors.initials: A
authors.lastname: Kozuki
authors.affiliation: Center for Innovative and Translational Medicine, Regenerative Medicine Group, Department of Surgery, Kochi Health Sciences Center, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Tokumaru
authors.affiliation: Center for Innovative and Translational Medicine, Regenerative Medicine Group, Department of Biostatistics, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Tasuo
authors.initials: T
authors.lastname: Iiyama
authors.affiliation: Center for Innovative and Translational Medicine, Regenerative Medicine Group, Department of Surgery, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Takeki
authors.initials: T
authors.lastname: Sugimoto
authors.affiliation: Center for Innovative and Translational Medicine, Regenerative Medicine Group, Department of Surgery, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Michiya
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Center for Innovative and Translational Medicine, Regenerative Medicine Group, Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Yokoyama
authors.affiliation: Center for Innovative and Translational Medicine, Regenerative Medicine Group, Department of Surgery, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hanazaki
mesh_terms: D000368:Aged; D001660:Biliary Tract Diseases / Q000601:surgery; D001786:Blood Glucose / Q000378:metabolism*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007362:Intensive Care Units; D008107:Liver Diseases / Q000601:surgery; D008297:Male; D010182:Pancreatic Diseases / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D011379:Prognosis; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000378:metabolism / Q000517:prevention & control*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin