Impact of Tight Glycemic Control on Outcome in Critically Ill Patients
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- Category: Vol. 78, March 2010
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Impact of Tight Glycemic Control on Outcome in Critically Ill Patients, MOHAMAD ASHRAF and AHMED MOWAFI
Abstract
Introduction: Hyperglycemia and insulin resistance are a common occurance in critically ill patients and are associated with adverse outcome. Thus, intensive insulin therapy is advocated increasingly for hyperglycemic intensive care unit (ICU) patients to redcue morbidity and mortality. Nevertheless convincing evidence of benefit comes mainly from trials carried out on surgical ICU patients while studies of the effects of intensive insulin therapy in mixed medical and surgical ICU patients have yielded conflicting results.
Methods: This study aimed at determining the efficacy of tight glycemic control and its impact on morbidity and mortality measures in mixed medical/surgical ICU patients. On admission, sixty patients were randomly assigned to recive intensive insulin therapy (IIT) (30 patients) using insulin infusion (target blood glucose = 90-149mg/dl) or conventional glycemic control (30 patients) (target blood glucose £199mg/dL).
Results: There was no statistically significant difference between both groups in their Demographic data. There was no statistically significant difference between the two groups as regards need for vasopressor use (p=0.79) or the need for renal replacement therapy (p=0.71), however, the incidence of acute kidney injury was lower in the tight control group (33.3% Vs 53.3%) but lacks statistical significance (p=0.09). Significant beneficial effect was found in the tight glycemic control group regarding incidence of bacteremia (p=0.037), mean duration of ICU stay (6.6 Vs 14.1 days, p=0.03) and accelerated weaning from mechanical ventilation (MV) (2.5 Vs 8.2 days, p=0.028). The tight glycemic control medical subgroup showed statistically significant less duration of ICU stay (7.9±3 Vs 16±4.9, p=0.05). There was no statistical significant difference between the two group regarding fre-quency of hypoglycemia [tight (16.7%) Vs conventional (30%), p=0.063)]. Lower mortality rate was found in the tight glycemic control group (26.7%) compared to conventional group (40%), yet with no statistical significance (p=0.412). Meanwhile on subgroup analysis, there was statistically significant lower mortality in surgical ICU patients who received IIT compared to those who received conventional glycemic regimen (6.7% Vs 26.7%, p=0.045).
Conclusion: Tight glycemic control significantly reduce morbidity in mixed medical and surgical ICU patients. There were reduction of newly acquired bacteremia during ICU course, acceleration of weaning from mechanical ventilation
and early discharge from intensive care unit with insignificant reduction in mortality rate among the whole mixed medi-cal/surgical ICU patients.