Tight glycaemic control: a survey of intensive care practice in large English hospitals

Excerpt

Sir: A recent historical cohort comparison of medical and surgical intensive care patients found that tight control of blood glucose with intravenous insulin was associated with reduced morbidity and mortality [1], corroborating the findings of an earlier prospective randomised trial in a surgical intensive care unit [2]. While the former was limited by study design, the latter has raised concerns regarding applicability, for a number of reasons. These include its setting in a surgical intensive care unit (ICU), a high proportion of cardiac surgical and male patients, low Acute Physiology and Chronic Health Evaluation APACHE II score on admission and mortality. Despite this, tight glycaemic control is being advocated as a standard of care in critically ill patients with sepsis [3] and, anecdotally at least, is being adopted as standard practice by many ICUs in the United Kingdom and around the world. The purpose of this survey is to assess the adoption of tight glycaemic control in ICUs in England, as a reflection of current UK intensive care practice. …